Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 20331 | NH |
NPI | 1043509847 |
---|---|
Provider Name | Amy M Chan |
First Address | Lebanon, NH 03756-0001 |
Second Address | Lebanon, NH 03756-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2011 |
Last Update Date | 25/05/2020 |