Provider Demographics
NPI:1215927504
Name:CHUA, ALVIN C (MD)
Entity type:Individual
Prefix:
First Name:ALVIN
Middle Name:C
Last Name:CHUA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX K299
Mailing Address - Street 2:18 CENTRAL STREET
Mailing Address - City:BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01506-0699
Mailing Address - Country:US
Mailing Address - Phone:508-867-9891
Mailing Address - Fax:508-867-7385
Practice Address - Street 1:18 CENTRAL STREET
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01506-0699
Practice Address - Country:US
Practice Address - Phone:508-867-9891
Practice Address - Fax:508-867-7385
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49566207R00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA330209666OtherTAX IDENTIFICATION NUMBER
MAJ06383OtherBLUE CROSS BLUE SHIELD OF MA
MA3022030Medicaid
MA330209666OtherTAX IDENTIFICATION NUMBER
MAJ06383OtherBLUE CROSS BLUE SHIELD OF MA