Provider Demographics
NPI:1184878837
Name:FAN, PANG-DIAN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:PANG-DIAN
Middle Name:
Last Name:FAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E 60TH ST
Mailing Address - Street 2:APT 15C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1514
Mailing Address - Country:US
Mailing Address - Phone:212-826-0731
Mailing Address - Fax:
Practice Address - Street 1:303 E 60TH ST
Practice Address - Street 2:APT 15C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1514
Practice Address - Country:US
Practice Address - Phone:212-826-0731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230836207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology