Provider Demographics
NPI:1467676494
Name:CHENG T PAN MD INC
Entity Type:Organization
Organization Name:CHENG T PAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:CHENG
Authorized Official - Middle Name:TSING
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-667-6774
Mailing Address - Street 1:227 SOUTH GARBER DRIVE
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-1183
Mailing Address - Country:US
Mailing Address - Phone:937-667-6774
Mailing Address - Fax:937-667-2826
Practice Address - Street 1:227 SOUTH GARBER DRIVE
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1183
Practice Address - Country:US
Practice Address - Phone:937-667-6774
Practice Address - Fax:937-667-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350560722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0817629Medicaid
PA0689751Medicare ID - Type Unspecified
OH0817629Medicaid