Provider Demographics
NPI:1366425803
Name:CHEN, EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:EDDIE
Other - Middle Name:CHUNG-YOU
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1627 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4209
Mailing Address - Country:US
Mailing Address - Phone:970-663-0135
Mailing Address - Fax:970-461-1422
Practice Address - Street 1:2000 BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5006
Practice Address - Country:US
Practice Address - Phone:970-203-6770
Practice Address - Fax:970-593-6055
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43220207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO840255530036OtherROCKY MTN HEALTH PLANS
CO93109776Medicaid
COP00231440OtherRAILROAD MEDICARE CARRIER
CO93109776Medicaid
COI27213Medicare UPIN
COCO304547Medicare PIN