Provider Demographics
NPI:1659366086
Name:PAN, CHENG TSING (MD)
Entity Type:Individual
Prefix:
First Name:CHENG
Middle Name:TSING
Last Name:PAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 S GARBER DR
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 S GARBER DR
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350560722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0817629Medicaid
OHPA0689751Medicare PIN
C64514Medicare UPIN