Healthcare Provider Details

I. General information

NPI: 1558325316
Provider Name (Legal Business Name): WILLIAM HAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 QUARRY LAKE DR SUITE 220
BALTIMORE MD
21209-3742
US

IV. Provider business mailing address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-9200
  • Fax: 410-601-8648
Mailing address:
  • Phone: 410-601-4811
  • Fax: 410-601-8648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD60796
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD60796
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD0060796
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: