Individual
SAMUEL CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D36655
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
283231300
—
MD
01
—
824211
MAMSI
MD
01
—
CJ4601
RAILROAD MEDICARE
MD
01
—
KDZ2
CAREFIRST BLUECROSS BLUES
MD
01
—
W111
FEDERAL EMPLOYEES PROGRAM
MD
Enumeration date
07/11/2006
Last updated
05/19/2022
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