Provider Demographics
NPI:1326131616
Name:CHAN, TRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
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 1:1650 GRAND CONCOURSE
Mailing Address - Street 2:ACN MEDICAL CLINIC 2ND FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7606
Mailing Address - Country:US
Mailing Address - Phone:718-590-1800
Mailing Address - Fax:718-518-5740
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:ACN MEDICAL CLINIC 2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:718-590-1800
Practice Address - Fax:718-518-5740
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02194392Medicaid
NY0029AL1Medicare ID - Type Unspecified