Provider Demographics
NPI:1134154917
Name:CHAN, BELINDA JULIET (MD)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:JULIET
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2941
Mailing Address - Country:US
Mailing Address - Phone:203-481-2280
Mailing Address - Fax:203-481-2275
Practice Address - Street 1:420 E MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2941
Practice Address - Country:US
Practice Address - Phone:203-481-2280
Practice Address - Fax:203-481-2275
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55933207R00000X
CT38053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT38053OtherCT STATE LICENSE
CT110009023OtherMEDICARE PROVIDER NUMBER
CT110009023OtherMEDICARE PROVIDER NUMBER
CAG53142Medicare UPIN