Healthcare Provider Details

I. General information

NPI: 1750655403
Provider Name (Legal Business Name): CHRISTOPHER CHAN M.D., PH. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 07/09/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 WESTPARK DR
MC LEAN VA
22102-3109
US

IV. Provider business mailing address

8008 WESTPARK DR
MC LEAN VA
22102-3109
US

V. Phone/Fax

Practice location:
  • Phone: 703-287-6400
  • Fax:
Mailing address:
  • Phone: 703-287-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number50824
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: