Provider Demographics
NPI:1962585042
Name:NGUYEN TAN, GIAC CHAN (MD)
Entity type:Individual
Prefix:
First Name:GIAC CHAN
Middle Name:
Last Name:NGUYEN TAN
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 1:171 GRANDVIEW AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2519
Mailing Address - Country:US
Mailing Address - Phone:203-755-2214
Mailing Address - Fax:203-596-1133
Practice Address - Street 1:171 GRANDVIEW AVE
Practice Address - Street 2:STE 105
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2519
Practice Address - Country:US
Practice Address - Phone:203-694-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028148207PE0005X, 207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E37056Medicare UPIN