Provider Demographics
NPI:1245692375
Name:CHAN, STEPHANIE (MD, FAAPMR)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD, FAAPMR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7133
Mailing Address - Country:US
Mailing Address - Phone:207-885-0011
Mailing Address - Fax:207-885-5851
Practice Address - Street 1:92 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7133
Practice Address - Country:US
Practice Address - Phone:207-885-0011
Practice Address - Fax:207-661-4501
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD23801208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation