Basic Information
Provider Information
NPI: 1235666868
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHEN
FirstName: XUGUANG
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 401 N BROADWAY ST STE 1440
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212870019
CountryCode: US
TelephoneNumber: 4109557390
FaxNumber: 4105021419
Practice Location
Address1: 101 MANNING DR
Address2:  
City: CHAPEL HILL
State: NC
PostalCode: 275144220
CountryCode: US
TelephoneNumber: 9199667890
FaxNumber: 9199669533
Other Information
ProviderEnumerationDate: 05/14/2017
LastUpdateDate: 08/31/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/31/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0001X2022-00735NCY Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology

No ID Information.


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