Provider Demographics
NPI:1144557240
Name:CLARA S.P. CHAN, MD, PC
Entity type:Organization
Organization Name:CLARA S.P. CHAN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-681-4600
Mailing Address - Street 1:9801 GEORGIA AVE
Mailing Address - Street 2:SUITE 337
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5276
Mailing Address - Country:US
Mailing Address - Phone:301-681-4600
Mailing Address - Fax:301-681-4648
Practice Address - Street 1:9801 GEORGIA AVE
Practice Address - Street 2:SUITE 337
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5276
Practice Address - Country:US
Practice Address - Phone:301-681-4600
Practice Address - Fax:301-681-4648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41828207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3000099OtherAMERICHOICE
MD910976OtherMAMSI
830006377OtherRAILROAD MEDICARE
MDOC22CSOtherCAREFIRST OF MD
3601884OtherUNITED HEALTHCARE
DC5074OtherCAREFIRST BCBS
0004140133OtherAETNA
MD083091700Medicaid
DC673016Medicare PIN
MD910976OtherMAMSI