Provider Demographics
NPI:1912962424
Name:CHAN, GEOFFREY W (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:W
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 1:76 SAGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2234
Mailing Address - Country:US
Mailing Address - Phone:857-919-1449
Mailing Address - Fax:
Practice Address - Street 1:1250 S COLLEGEVILLE RD
Practice Address - Street 2:UP4420
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2990
Practice Address - Country:US
Practice Address - Phone:610-917-5256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432135207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology