Provider Demographics
NPI:1255421467
Name:CHEN, POLY (MD)
Entity type:Individual
Prefix:DR
First Name:POLY
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 LIBERTY ST NE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-8388
Mailing Address - Country:US
Mailing Address - Phone:503-371-1010
Mailing Address - Fax:503-371-0805
Practice Address - Street 1:2480 LIBERTY ST NE
Practice Address - Street 2:SUITE 110
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-8380
Practice Address - Country:US
Practice Address - Phone:503-371-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48838020207L00000X
ORMD29376208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology