Provider Demographics
NPI:1316966393
Name:CHAN, DO (MD)
Entity type:Individual
Prefix:
First Name:DO
Middle Name:
Last Name:CHAN
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 1:210 NAHANTON ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2954
Mailing Address - Country:US
Mailing Address - Phone:617-969-0790
Mailing Address - Fax:
Practice Address - Street 1:211 PARK ST
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3143
Practice Address - Country:US
Practice Address - Phone:508-236-7430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225346207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine