Healthcare Provider Details

I. General information

NPI: 1093064214
Provider Name (Legal Business Name): QIULU PAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14225 NEWBROOK DR QUEST DIAGNOSTICS
CHANTILLY VA
20151-2228
US

IV. Provider business mailing address

14225 NEWBROOK DR QUEST DIAGNOSTICS
CHANTILLY VA
20151-2228
US

V. Phone/Fax

Practice location:
  • Phone: 703-802-6900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: