Provider Demographics
NPI:1154381721
Name:CHEN, DAVID WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WAYNE
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2314
Mailing Address - Country:US
Mailing Address - Phone:617-325-0520
Mailing Address - Fax:617-325-9115
Practice Address - Street 1:942 SOUTH ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2314
Practice Address - Country:US
Practice Address - Phone:617-325-0520
Practice Address - Fax:617-325-9047
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6176518Medicaid
MA6365OtherHARVARD PILGRIM ID
MA52179OtherLICENSE
MA52179OtherLICENSE
MA6365OtherHARVARD PILGRIM ID
MAJ02922Medicare ID - Type Unspecified