Healthcare Provider Details

I. General information

NPI: 1154426385
Provider Name (Legal Business Name): RICHARD O. HAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACCORKLE AVE SE STE 101
CHARLESTON WV
25304-1215
US

IV. Provider business mailing address

3100 MACCORKLE AVE SE STE 101
CHARLESTON WV
25304-1215
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-8200
  • Fax: 304-388-7100
Mailing address:
  • Phone: 304-388-8200
  • Fax: 304-388-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME80649
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: