Provider Demographics
NPI:1285602573
Name:CHEN, RICHARD D (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
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 1:801 MARBLE WAY
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-8594
Mailing Address - Country:US
Mailing Address - Phone:707-636-4363
Mailing Address - Fax:844-268-1466
Practice Address - Street 1:801 MARBLE WAY
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-8594
Practice Address - Country:US
Practice Address - Phone:707-636-4363
Practice Address - Fax:844-268-1466
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X
CAG78024208VP0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No175F00000XOther Service ProvidersNaturopath
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400255941Medicare UPIN
MA2152827Medicaid
MAJ14933Medicare PIN