Healthcare Provider Details

I. General information

NPI: 1679926547
Provider Name (Legal Business Name): CAROL NHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD DIVISION OF PEDIATRIC OTOLARYNGOLOGY AT CHOP
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

201 S 18TH ST 1103
PHILADELPHIA PA
19103-5957
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1190
  • Fax: 215-590-4668
Mailing address:
  • Phone: 267-303-2564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT210913
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: