Provider Demographics
NPI:1205807575
Name:CHAN-LAM, PATRICK (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:CHAN-LAM
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 1:825 WEHRLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1718
Mailing Address - Country:US
Mailing Address - Phone:716-634-3502
Mailing Address - Fax:716-634-1930
Practice Address - Street 1:825 WEHRLE DRIVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-1718
Practice Address - Country:US
Practice Address - Phone:716-634-3502
Practice Address - Fax:716-634-1930
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209313207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG00179Medicare UPIN
NYCC9161Medicare ID - Type Unspecified