Provider Demographics
NPI:1427207778
Name:CHAN, KATHY H (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:H
Last Name:CHAN
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:1700 EAST COLD SPRING LANE
Mailing Address - Street 2:MORGAN STATE UNIVERSITY
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21251-0001
Mailing Address - Country:US
Mailing Address - Phone:443-885-1677
Mailing Address - Fax:443-882-8232
Practice Address - Street 1:MORGAN STATE UNIVERSITY
Practice Address - Street 2:WOOLFORD INFIRMARY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21251-0001
Practice Address - Country:US
Practice Address - Phone:443-885-1677
Practice Address - Fax:443-882-8232
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC01371363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant