Healthcare Provider Details

I. General information

NPI: 1518751965
Provider Name (Legal Business Name): ALLEN CHAN RN-BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 TREMONT ST
BOSTON MA
02116-5603
US

IV. Provider business mailing address

260 TREMONT ST
BOSTON MA
02116-5603
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5400
  • Fax:
Mailing address:
  • Phone: 617-636-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2302961
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: