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Individual

DR. TAI CHI SHAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
501 NORTH FREDERICK AVENUE, GAITHERSBURG, MD 20877-2598
(301) 258-7203
(301) 258-7294
Mailing address
2201 EAST JEFFERSON STREET, PPQA MEDICARE COMPLIANCE UNIT 6, ROCKVILLE, MD 20852-4908
(301) 816-6660
(301) 816-6308

Taxonomy

Speciality
Code
Description
License number
State
152WP0200X
Pediatric Optometrist
0101042637
VA
152WP0200X
Pediatric Optometrist
Primary
D45187
MD
152WP0200X
Pediatric Optometrist
MD17409
DC

Other

Enumeration date
12/04/2006
Last updated
07/08/2007
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