Provider Demographics
NPI:1922321348
Name:JEFF J. S. PAN, MD, PC
Entity Type:Organization
Organization Name:JEFF J. S. PAN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:J S
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-534-0414
Mailing Address - Street 1:6408 SEVEN CORNERS PL
Mailing Address - Street 2:SUITE L
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2011
Mailing Address - Country:US
Mailing Address - Phone:703-534-0414
Mailing Address - Fax:703-534-7347
Practice Address - Street 1:6408 SEVEN CORNERS PL
Practice Address - Street 2:STE L
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2011
Practice Address - Country:US
Practice Address - Phone:703-534-0414
Practice Address - Fax:703-534-7347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0101041614208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007500459Medicaid
VAE11542Medicare UPIN
VA007500459Medicaid