Provider Demographics
NPI:1417940941
Name:CHAN, EDWARD FUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:FUNG
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 CHESLEY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1761
Mailing Address - Country:US
Mailing Address - Phone:610-566-7111
Mailing Address - Fax:610-891-6735
Practice Address - Street 1:101 CHESLEY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1761
Practice Address - Country:US
Practice Address - Phone:610-566-7111
Practice Address - Fax:610-891-6735
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069710L207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA034088LGVMedicare ID - Type Unspecified
PAH07800Medicare UPIN