Provider Demographics
NPI:1730259789
Name:CHEN, ENN ALEXANDRIA (MD)
Entity type:Individual
Prefix:
First Name:ENN
Middle Name:ALEXANDRIA
Last Name:CHEN
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 1:1600 E HIGH ST
Mailing Address - Street 2:RADIOLOGY DEPARTMENT
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-5008
Mailing Address - Country:US
Mailing Address - Phone:610-327-7282
Mailing Address - Fax:610-705-5675
Practice Address - Street 1:1600 E HIGH ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5008
Practice Address - Country:US
Practice Address - Phone:610-327-7282
Practice Address - Fax:610-705-5675
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4350622085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA183219Medicare PIN