Provider Demographics
NPI:1982796561
Name:PAN, MING (MB, PHD)
Entity Type:Individual
Prefix:DR
First Name:MING
Middle Name:
Last Name:PAN
Suffix:
Gender:M
Credentials:MB, PHD
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Mailing Address - Street 1:1700 S LINCOLN AVE
Mailing Address - Street 2:SURGERY VA MEDICAL CENTER
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7529
Mailing Address - Country:US
Mailing Address - Phone:717-272-6621
Mailing Address - Fax:717-531-6939
Practice Address - Street 1:1700 S LINCOLN AVE
Practice Address - Street 2:SURGERY VA MEDICAL CENTER
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7529
Practice Address - Country:US
Practice Address - Phone:717-272-6621
Practice Address - Fax:717-531-6939
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD-070392-L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery