Healthcare Provider Details

I. General information

NPI: 1487693537
Provider Name (Legal Business Name): MIAN A. JAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 MAPLE AVE.
WEST CHESTER PA
19380-4416
US

IV. Provider business mailing address

531 MAPLE AVENUE
WEST CHESTER PA
19380-4416
US

V. Phone/Fax

Practice location:
  • Phone: 610-692-4382
  • Fax: 610-430-6820
Mailing address:
  • Phone: 610-692-4382
  • Fax: 610-430-6820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD028956
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: