Basic Information
| Provider Information | |||||||||
| NPI: | 1235135476 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 160 | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035610160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038238600 | ||||||||
| FaxNumber: | 6038238688 | ||||||||
| Practice Location | |||||||||
| Address1: | 1095 PROFILE ROAD | ||||||||
| Address2: | |||||||||
| City: | FRANCONIA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038238600 | ||||||||
| FaxNumber: | 6038238688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 01/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 12418 | NH | N | Other Service Providers | Specialist | 207X00000X | 12418 | NH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 30204642 | 05 | NH | MEDICAID |