MEDICARE: JIANHUA FANG HTL (ASCP)

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	246QH0600X	Histology Specialist/Technologist	3609	IL

General Provider Information

NPI Number	:	1558742551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIANHUA FANG HTL (ASCP)

Provider Business Mailing Address
First Line	:	1809 STRAHLE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2322
Country	:	US
Telephone Number	:	215-645-2470
Fax Number	:

Provider Business Practice Location Address
First Line	:	1809 STRAHLE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2322
Country	:	US
Telephone Number	:	215-645-2470
Fax Number	:

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

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	06/15/2015

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