Provider Demographics
NPI:1639390214
Name:CHAN, JUDY LAI YEE (NP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:LAI YEE
Last Name:CHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 OLD GEORGETOWN ROAD
Mailing Address - Street 2:SUBURBAN HOSPITAL
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-896-2019
Mailing Address - Fax:301-896-7346
Practice Address - Street 1:8600 OLD GEORGETOWN ROAD
Practice Address - Street 2:SUBURBAN HOSPITAL
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-896-2019
Practice Address - Fax:301-896-7346
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR126848363LA2200X
DCRN63213363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health