=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477131381
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMIE CHAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2021
-----------------------------------------------------
Last Update Date | 03/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 EDGEWATER DR STE 102
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02062-4644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-928-7668
-----------------------------------------------------
Fax | 781-352-2274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 EDGEWATER DR STE 102
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02062-4644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-928-7668
-----------------------------------------------------
Fax | 781-352-2274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 1018972
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------