Provider Demographics
NPI:1033787767
Name:CHAN, MARIEL (MD)
Entity Type:Individual
Prefix:
First Name:MARIEL
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
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:SUMMIT PACIFIC MEDICAL CENTER
Mailing Address - Street 2:600 E. MAIN STREET
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541
Mailing Address - Country:US
Mailing Address - Phone:360-346-2222
Mailing Address - Fax:
Practice Address - Street 1:600 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541
Practice Address - Country:US
Practice Address - Phone:360-346-2222
Practice Address - Fax:360-346-2157
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program