Provider Demographics
NPI:1477131381
Name:CHAN, JAMIE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:CHAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 EDGEWATER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4644
Mailing Address - Country:US
Mailing Address - Phone:508-928-7668
Mailing Address - Fax:781-352-2274
Practice Address - Street 1:3 EDGEWATER DR STE 102
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4644
Practice Address - Country:US
Practice Address - Phone:508-928-7668
Practice Address - Fax:781-352-2274
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1018972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine