Provider Demographics
NPI:1538171277
Name:HA, CHEN (MD)
Entity type:Individual
Prefix:
First Name:CHEN
Middle Name:
Last Name:HA
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 1:505 WALTON AVE.
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9583
Mailing Address - Country:US
Mailing Address - Phone:856-938-7976
Mailing Address - Fax:
Practice Address - Street 1:1919 GREENTREE RD.
Practice Address - Street 2:SUITE C
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:856-938-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0099207Q00000X
NJ25MA08691900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0244571Medicaid
NJ0244571Medicaid