Provider Demographics
NPI:1063477792
Name:CHAN, GINA (MD)
Entity Type:Individual
Prefix:
First Name:GINA
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 1:2700 SILVERSIDE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3719
Mailing Address - Country:US
Mailing Address - Phone:302-478-0400
Mailing Address - Fax:302-478-3827
Practice Address - Street 1:2700 SILVERSIDE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3719
Practice Address - Country:US
Practice Address - Phone:302-478-0400
Practice Address - Fax:302-478-3827
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006882173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000034821Medicaid
DE1480583OtherUNITED HEALTH CARE
DEDE11112OtherBCBSDE
DE2243460000OtherAMERIHEALTH
DEP00055687OtherRAILROAD MEDICARE
DE1480583OtherUNITED HEALTH CARE
DE2243460000OtherAMERIHEALTH
G05426Medicare UPIN
DE017427Medicare ID - Type UnspecifiedMEDICARE