Provider Demographics
NPI:1396712105
Name:CHAN, IRIS TANCHI (MD PHD)
Entity type:Individual
Prefix:DR
First Name:IRIS
Middle Name:TANCHI
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:400 BROOKLINE AVENUE
Mailing Address - Street 2:APT 21 G
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-278-6064
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY STREET
Practice Address - Street 2:SUITE D1 B30
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-6922
Practice Address - Fax:617-355-9092
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA210272207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ27354OtherBLUE CROSS BLUE SHIELD
4637244OtherCIGNA
MA2043700Medicaid
AA11737OtherHPHC DFCI ONLY
210272OtherTUFTS
3717129OtherAETNA US HEALTHCARE
I09503Medicare UPIN
210272OtherTUFTS