Individual
SAMUEL CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11110 MEDICAL CAMPUS RD STE 150, HAGERSTOWN, MD 21742-6755
(301) 665-4825
(301) 665-4826
Mailing address
11116 MEDICAL CAMPUS RD, HAGERSTOWN, MD 21742-6710
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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