Provider Demographics
NPI:1962416958
Name:CHAM, ANITA LEE (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:LEE
Last Name:CHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W MAIN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834
Mailing Address - Country:US
Mailing Address - Phone:973-627-9635
Mailing Address - Fax:973-625-7484
Practice Address - Street 1:35 W MAIN ST
Practice Address - Street 2:STE 201
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834
Practice Address - Country:US
Practice Address - Phone:973-627-9635
Practice Address - Fax:973-625-7484
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA34748174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06360Medicare UPIN