Healthcare Provider Details

I. General information

NPI: 1174790919
Provider Name (Legal Business Name): JEFFREY TAI PAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 07/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 CHAPEL ST ANESTHESIA ASSOCIATES OF NEW HAVEN
NEW HAVEN CT
06511-4411
US

IV. Provider business mailing address

1423 CHAPEL ST ANESTHESIA ASSOCIATES OF NEW HAVEN
NEW HAVEN CT
06511-4411
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-3538
  • Fax: 203-867-5461
Mailing address:
  • Phone: 203-789-3538
  • Fax: 203-867-5461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number046571
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: