Provider Demographics
NPI:1093064214
Name:PAN, QIULU
Entity Type:Individual
Prefix:
First Name:QIULU
Middle Name:
Last Name:PAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14225 NEWBROOK DR
Mailing Address - Street 2:QUEST DIAGNOSTICS
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14225 NEWBROOK DR
Practice Address - Street 2:QUEST DIAGNOSTICS
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2228
Practice Address - Country:US
Practice Address - Phone:703-802-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics