MEDICARE: DR. CAROLINE HAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101234511	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	353710	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1750328258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLINE HAN MD

Provider Business Mailing Address
First Line	:	860 OMNI BLVD
Second Line	:	STE 101
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-4430
Country	:	US
Telephone Number	:	757-232-8769
Fax Number	:	757-232-8875

Provider Business Practice Location Address
First Line	:	813 INDEPENDENCE BLVD STE A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6004
Country	:	US
Telephone Number	:	757-301-7729
Fax Number	:	757-301-7837

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	06/03/2020

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