1306133350 NPI number — DR. JANICE CHAN M.D.

Table of content: DR. JANICE CHAN M.D. (NPI 1306133350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306133350 NPI number — DR. JANICE CHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAN
Provider First Name:
JANICE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306133350
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4727 FRIENDSHIP AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15224-1779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-235-5810
Provider Business Mailing Address Fax Number:
412-235-5890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 EKASTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16055-9751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-352-8422
Provider Business Practice Location Address Fax Number:
724-352-8426
Provider Enumeration Date:
06/28/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207QG0300X , with the licence number:  MD452258 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD452258 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)