Provider Demographics
NPI:1497830699
Name:CHAN, THERESA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:Y
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 1:1901 SULPHUR SPRING RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2943
Mailing Address - Country:US
Mailing Address - Phone:410-737-1292
Mailing Address - Fax:410-536-1634
Practice Address - Street 1:1901 SULPHUR SPRING RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-2943
Practice Address - Country:US
Practice Address - Phone:410-737-1292
Practice Address - Fax:410-536-1634
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054390207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology