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General NPI Number Information
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NPI Number | 1801488762
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Entity Type | Individual
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Provider Name | SAMANTHA CHAN
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Gender | Female
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 840 WINTER STREET BOSTON ORTHO AND SPINE
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City | WALTHAM
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State | MA
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Zip | 02451
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Country | US
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Telephone | 617-738-8642
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Fax |
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Provider Business Mailing Address
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Address Line | 840 WINTER ST BOSTON ORTHOPAEDICS AND SPINE
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City | WALTHAM
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State | MA
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Zip | 02451-1433
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA8574
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License Number State | MA
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