Provider Demographics
NPI:1063650315
Name:CHAN, MARIA CRISTINA CANGA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA CRISTINA
Middle Name:CANGA
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA CRISTINA
Other - Middle Name:
Other - Last Name:CHAN-MELLANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:80 GUION PL APT 2U
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-3823
Mailing Address - Country:US
Mailing Address - Phone:914-576-2938
Mailing Address - Fax:
Practice Address - Street 1:40 CANDACE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-3747
Practice Address - Country:US
Practice Address - Phone:401-444-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-24
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD13267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine