Provider Demographics
NPI:1902077324
Name:CHAN, TAMMY W (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:W
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S CLEVELAND AVE
Mailing Address - Street 2:STE D
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8958
Mailing Address - Country:US
Mailing Address - Phone:614-865-7600
Mailing Address - Fax:614-392-2546
Practice Address - Street 1:550 S CLEVELAND AVE
Practice Address - Street 2:STE D
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8958
Practice Address - Country:US
Practice Address - Phone:614-865-7600
Practice Address - Fax:614-392-2546
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11011777A207V00000X
OH35092332207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2885794Medicaid