Individual
MICHELLE CHRISTIANA FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
5950 SR6, TUNKHANNOCK,, PA 18457
(570) 836-2161
Mailing address
11781 LEE JACKSON MEMORIAL HWY, SUITE 550, FAIRFAX, VA 22033-3309
(571) 777-5102
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
OS009565L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001668739 0006
—
PA
05
—
0016687390007
—
PA
01
—
P00393423
RR MEDICARE
—
Enumeration date
01/25/2006
Last updated
09/14/2020
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