Provider Demographics
NPI:1770758476
Name:CHAN, ADRIAN (MD)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 CORBIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-2298
Mailing Address - Country:US
Mailing Address - Phone:860-612-6305
Mailing Address - Fax:860-612-6304
Practice Address - Street 1:2150 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-2298
Practice Address - Country:US
Practice Address - Phone:860-612-6305
Practice Address - Fax:860-612-6304
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0028542084N0400X
NJ25MB089713002084N0400X
CT746042084N0400X
PAMD4428322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD974285OtherCAREFIRST MD
PA30103337OtherAMERIHEALTH MERCY-WMG
PA102610692Medicaid
PA417519OtherUPMC
NY02916952Medicaid
PA2636016OtherHIGHMARK BLUE SHIELD
MD974285OtherCAREFIRST MD
NY02916952Medicaid