Provider Demographics
NPI:1538204219
Name:CHEN, CHEUNJU (MD)
Entity type:Individual
Prefix:DR
First Name:CHEUNJU
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHENJU
Other - Middle Name:
Other - Last Name:CHENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:17 WESTERN MARYLAND PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5471
Practice Address - Country:US
Practice Address - Phone:301-797-9240
Practice Address - Fax:301-797-4234
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00670132084N0400X
PAMD4333712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD92575701OtherMARYLAND BLUE SHIELD-PPN
MDW2660018OtherMARYLAND BLUE SHIELD-REGIONAL
MD414186500OtherMARYLAND MEDICAL ASSISTANCE
PA2013145OtherHIGHMARK BLUE SHIELD-PA
PA2016137OtherHIGHMARK BLUE SHIELD-MD
MDW2660018OtherMARYLAND BLUE SHIELD-REGIONAL
PA121536M0TMedicare PIN