Healthcare Provider Details

I. General information

NPI: 1700114998
Provider Name (Legal Business Name): ELAINE CHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTH ACADEMY AVE
DANVILLE PA
17822-4903
US

IV. Provider business mailing address

100 NORTH ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-214-5681
  • Fax: 570-271-6578
Mailing address:
  • Phone: 570-214-9907
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD451348
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN 18307
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD451348
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: