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General NPI Number Information
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NPI Number | 1174740005
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Entity Type | Individual
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Provider Name | JOHN J. PAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 840 HARRISON AVE
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City | BOSTON
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State | MA
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Zip | 02118-2905
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Country | US
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Telephone | 617-638-6610
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Fax | 617-638-6616
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Provider Business Mailing Address
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Address Line | 960 MASSACHUSETTS AVE FL 2
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City | BOSTON
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State | MA
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Zip | 02118-2690
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Country | US
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Telephone | 617-414-5405
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Fax | 617-414-6038
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A89915
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 42588
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 231127
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License Number State | MA
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