Individual
GRACE FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
801 OSTRUM ST, RADIATION ONCOLOGY DEPT, BETHLEHEM, PA 18015-1000
(484) 526-4841
(484) 526-4671
Mailing address
PO BOX 513029, PHILADELPHIA, PA 19175-3029
(855) 709-3112
(302) 709-2413
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
25MA09450900
NJ
2085R0001X
Radiation Oncology Physician
Primary
MD433763
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0212491
—
NJ
05
—
102190918
—
PA
01
—
P00764685
RAILROAD MEDICARE
PA
Enumeration date
06/19/2007
Last updated
05/01/2014
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