Healthcare Provider Details

I. General information

NPI: 1265658116
Provider Name (Legal Business Name): PHILIP A CHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CENTRAL ST
PROVIDENCE RI
02907-2201
US

IV. Provider business mailing address

PO BOX 6088
PROVIDENCE RI
02940-6088
US

V. Phone/Fax

Practice location:
  • Phone: 401-621-8200
  • Fax: 917-720-9002
Mailing address:
  • Phone: 401-648-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD12984
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: