Individual
DIANE CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., PH.D.
Contact information
Practice address
55 FRUIT STREET, WACC 720, BOSTON, MA 02114
(617) 726-5523
Mailing address
55 FRUIT STREET, WACC 720 ATTN ANDREA RILEY, BOSTON, MA 02114
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
270967
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2013
Last updated
06/20/2019
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