MEDICARE: CHENG T PAN MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	35056072	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467676494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHENG T PAN MD INC

Provider Business Mailing Address
First Line	:	227 SOUTH GARBER DRIVE
Second Line	:
City	:	TIPP CITY
State	:	OH
Zip	:	45371-1183
Country	:	US
Telephone Number	:	937-667-6774
Fax Number	:	937-667-2826

Provider Business Practice Location Address
First Line	:	227 SOUTH GARBER DRIVE
Second Line	:
City	:	TIPP CITY
State	:	OH
Zip	:	45371-1183
Country	:	US
Telephone Number	:	937-667-6774
Fax Number	:	937-667-2826

Authorized Official
Title or Position	:	PRESIDENT OF CORPORATION
Name	:	DR. CHENG TSING PAN
Credential	:	MD
Telephone Number	:	937-667-6774

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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