Basic Information
| Provider Information | |||||||||
| NPI: | 1902806813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUA | ||||||||
| FirstName: | CHERRIE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHUA-PO | ||||||||
| OtherFirstName: | CHERRIE | ||||||||
| OtherMiddleName: | C | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 65 SPRINGFIELD RD | ||||||||
| Address2: | WESTFIELD PEDIATRICS | ||||||||
| City: | WESTFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010851855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135628330 | ||||||||
| FaxNumber: | 4135623430 | ||||||||
| Practice Location | |||||||||
| Address1: | 65 SPRINGFIELD RD | ||||||||
| Address2: | WESTFIELD PEDIATRICS | ||||||||
| City: | WESTFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010851855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135628330 | ||||||||
| FaxNumber: | 4135623430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 10/20/2011 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | 215726 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2000270 | 01 | MA MEDICAID - PCC | OTHER | 215726 | 01 | CONNECTICARE OF MA | OTHER | 043202198 | 01 | FIRST HEALTH | OTHER | 043202198 | 01 | BEACH STREET | OTHER | J25781 | 01 | HMO BLUE | OTHER | 2000270 | 05 | MA | MEDICAID | 4278616 | 01 | CIGNA | OTHER | 043202198 | 01 | GREAT WEST HEALTH PLAN | OTHER | 043202198 | 01 | HMC - PPO | OTHER | J25781 | 01 | MA | BLUE CROSS BLUE SHEILD | OTHER | 043202198 | 01 | CBA | OTHER | 043202198 | 01 | CONSOLIDATED HEALTH PLAN | OTHER | 043202198 | 01 | HEALTH CARE VALUE MANAGEM | OTHER | 0000000024681 | 01 | BOSTON MEDICAL CENTER - H | OTHER | 31784 | 01 | HEALTH NEW ENGLAND | OTHER | 42671 | 01 | CHILDRENS MEDICAL PLAN | OTHER | 043202198 | 01 | MULTIPLAN | OTHER | 205892 | 01 | HARVARD/PILGRIM | OTHER |