Provider Demographics
NPI:1821296468
Name:CHAN, DANIEL W (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:CHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12925 WEXFORD PARK
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1401
Mailing Address - Country:US
Mailing Address - Phone:410-955-2674
Mailing Address - Fax:443-287-6388
Practice Address - Street 1:12925 WEXFORD PARK
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1401
Practice Address - Country:US
Practice Address - Phone:410-955-2674
Practice Address - Fax:443-287-6388
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician