Provider Demographics
NPI:1548396773
Name:CHAN, CHI-CHAO (MD)
Entity type:Individual
Prefix:DR
First Name:CHI-CHAO
Middle Name:
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 1:10 CENTER DR
Mailing Address - Street 2:10N103, NIH/NEI
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-1857
Mailing Address - Country:US
Mailing Address - Phone:301-496-0417
Mailing Address - Fax:301-402-8664
Practice Address - Street 1:10 CENTER DR
Practice Address - Street 2:10N103, NIH/NEI
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-1857
Practice Address - Country:US
Practice Address - Phone:301-496-0417
Practice Address - Fax:301-402-8664
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018294207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology