=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386855542
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERNICE HOANGLAN DOAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2007
-----------------------------------------------------
Last Update Date | 10/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 557 BROOKDALE DR
-----------------------------------------------------
City | STATESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28677-4107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-409-2919
-----------------------------------------------------
Fax | 215-393-0809
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 172 DEER RUN DR
-----------------------------------------------------
City | TROUTMAN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28166-7653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-409-2919
-----------------------------------------------------
Fax | 215-393-0809
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BERNICE HOANGLAN DOAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 800-409-2919
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------