Provider Demographics
NPI:1427341098
Name:CHAN, MING CHEONG DEREK (MD)
Entity type:Individual
Prefix:DR
First Name:MING
Middle Name:CHEONG DEREK
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M.C.
Other - Middle Name:DEREK
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7128 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SODUS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:14555-9501
Mailing Address - Country:US
Mailing Address - Phone:315-483-6798
Mailing Address - Fax:315-483-6798
Practice Address - Street 1:7128 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:SODUS POINT
Practice Address - State:NY
Practice Address - Zip Code:14555-9501
Practice Address - Country:US
Practice Address - Phone:315-483-6798
Practice Address - Fax:315-483-6798
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106299207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology