Provider Demographics
NPI:1891746814
Name:CHAN, ALFREDO R (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:R
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:105 WEBSTER STREET
Mailing Address - Street 2:WEBSTER PLACE UNIT 6
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1227
Mailing Address - Country:US
Mailing Address - Phone:781-878-8200
Mailing Address - Fax:781-878-5538
Practice Address - Street 1:105 WEBSTER STREET
Practice Address - Street 2:WEBSTER PLACE UNIT 6
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1227
Practice Address - Country:US
Practice Address - Phone:781-878-8200
Practice Address - Fax:781-878-5538
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA706532084P0800X, 2084P0802X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3059472Medicaid
MA3059472Medicaid
J10402Medicare ID - Type Unspecified