Provider Demographics
NPI:1487693537
Name:JAN, MIAN A (MD)
Entity type:Individual
Prefix:
First Name:MIAN
Middle Name:A
Last Name:JAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 MAPLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4416
Mailing Address - Country:US
Mailing Address - Phone:610-692-4382
Mailing Address - Fax:610-430-6820
Practice Address - Street 1:531 MAPLE AVE.
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4416
Practice Address - Country:US
Practice Address - Phone:610-692-4382
Practice Address - Fax:610-430-6820
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028956207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001551416OtherUNITED HEALTHCARE
PA1395524Medicaid
PA509943OtherHIGHMARK
PA011040000OtherKEYSTONE
PA001395524Medicaid
PA060027745OtherTRAVELERS MEDICARE
PA8994406OtherCIGNA
E69432OtherMEDICARE UPIN
PAP2808773OtherOXFORD
PA1395524Medicaid