Samuel Chan, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

D36655 Issued in MD

Practice address

11110 Medical Campus Rd Ste 150
Hagerstown, MD 21742-6755

Phone

(301) 665-4825

Fax

(301) 665-4826

NPI assigned

Jul 11, 2006

Last updated

May 19, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Samuel Chan, M.D.

  • Community Health Worker
  • Hagerstown, MD
  • NPI 1043408230
  NPD (past) Authorized official
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652918400000",
    "number": "1972538841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11116 MEDICAL CAMPUS RD",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD STE 150",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426755",
            "telephone_number": "301-665-4825",
            "fax_number": "301-665-4826"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "324 E Antietam St",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Hagerstown",
            "state": "MD",
            "postal_code": "217405754",
            "country_code": "US",
            "telephone_number": "301-797-8822",
            "fax_number": "301-790-3748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAN",
        "first_name": "SAMUEL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D36655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUECROSS BLUES",
            "identifier": "KDZ2",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "283231300",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "824211",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL EMPLOYEES PROGRAM",
            "identifier": "W111",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CJ4601",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rajwinder Kaur Chahal
• Renee Colby Chalker, PT
• Ashika Chaluvadi, DO
• Maureen Courtenay Chamberlain, LCSW-C
• Rose Marie Chan, M.D.
• Taylore Chandler
• Chaney Counseling Services
• Beth Chaney, LCPC
• Charles Robert Chaney, M.D.
• Wai Yin Teresa Chang

• Internal Medicine Physician in Hagerstown, MD
• Providers in Hagerstown, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.