Provider Demographics
NPI:1073510418
Name:CHAN, JENNIFER P (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 CHAMBERS HILL DR
Mailing Address - Street 2:STE 200
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-7304
Mailing Address - Country:US
Mailing Address - Phone:717-709-7922
Mailing Address - Fax:717-263-2055
Practice Address - Street 1:820 5TH AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4219
Practice Address - Country:US
Practice Address - Phone:717-263-4313
Practice Address - Fax:717-263-0500
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2019-12-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD068706L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001789378Medicaid
036218KQCMedicare ID - Type Unspecified
PA001789378Medicaid