Basic Information
Provider Information
NPI: 1306857990
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PAN
FirstName: ZHEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
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Mailing Information
Address1: P.O. BOX 191
Address2:  
City: ROCKLAND
State: DE
PostalCode: 197230191
CountryCode: US
TelephoneNumber: 3026514000
FaxNumber: 3026514945
Practice Location
Address1: 833 CHESTNUT STREET EAST, SUITE 300
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191074405
CountryCode: US
TelephoneNumber: 2158618800
FaxNumber: 2158618815
Other Information
ProviderEnumerationDate: 08/10/2006
LastUpdateDate: 09/12/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XC50000478DEN Allopathic & Osteopathic PhysiciansFamily Medicine 
363A00000XC5000478DEY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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