Healthcare Provider Details

I. General information

NPI: 1538421078
Provider Name (Legal Business Name): ALLISON CHAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 01/16/2021
Certification Date: 01/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 HIGHLANDS DR
LITITZ PA
17543
US

IV. Provider business mailing address

1500 HIGHLANDS DR
LITITZ PA
17543-7694
US

V. Phone/Fax

Practice location:
  • Phone: 717-988-0000
  • Fax: 717-782-5716
Mailing address:
  • Phone: 717-988-0000
  • Fax: 717-782-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOT014663
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS018201
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: