MEDICARE: CHRISTIAN TAE HO HAN M.P.T.

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	225100000X	Physical Therapist	20173	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	338063	OTHER	MD	MAMSI LIFE MD IPA
2	683203200	OTHER	MD	AMERIGROUP
3	LK24AT	OTHER	MD	CF BLUE CROSS BLUE SHIELD
4	S9860005	OTHER	DC	CF BLUE CROSS BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477607109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN TAE HO HAN M.P.T.

Provider Business Mailing Address
First Line	:	8492 BALTIMORE NATIONAL PIKE
Second Line	:	STE 207
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-3378
Country	:	US
Telephone Number	:	301-776-0421
Fax Number	:	301-598-7432

Provider Business Practice Location Address
First Line	:	3836 INTERNATIONAL DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-1548
Country	:	US
Telephone Number	:	301-598-7420
Fax Number	:	301-598-7432

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/12/2017

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