Provider Demographics
NPI:1447231121
Name:CHAN, ROSE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ROSE
Middle Name:MARIE
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:MARIE
Other - Last Name:SRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1500 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3112
Mailing Address - Country:US
Mailing Address - Phone:301-791-4400
Mailing Address - Fax:301-739-8949
Practice Address - Street 1:1500 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3112
Practice Address - Country:US
Practice Address - Phone:301-791-4400
Practice Address - Fax:301-739-8949
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026416208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F19310Medicare UPIN