Provider Demographics
NPI:1154426385
Name:HAN, RICHARD O (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:O
Last Name:HAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MACCORKLE AVE SE STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1215
Mailing Address - Country:US
Mailing Address - Phone:304-388-8200
Mailing Address - Fax:304-388-7100
Practice Address - Street 1:3100 MACCORKLE AVE SE STE 101
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1215
Practice Address - Country:US
Practice Address - Phone:304-388-8200
Practice Address - Fax:304-388-7100
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80649207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259096400Medicaid
FL35569OtherBLUE CROSS BLUE SHIELD
FL35569ZMedicare PIN
G90582Medicare UPIN
FL259096400Medicaid