Provider Demographics
NPI:1285654947
Name:HAN, LAWRENCE S (DPM)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:S
Last Name:HAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20397 ROUTE 19
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6133
Mailing Address - Country:US
Mailing Address - Phone:724-553-5706
Mailing Address - Fax:724-553-5357
Practice Address - Street 1:20397 ROUTE 19
Practice Address - Street 2:SUITE 230
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6133
Practice Address - Country:US
Practice Address - Phone:724-553-5706
Practice Address - Fax:724-553-5357
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004233L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232872943OtherDEVON
PA2778012OtherAETNA
PA480022261OtherRAILROAD MEDICARE
892844OtherBLUE SHIELD
PA0072971730002Medicaid
PA1525519OtherUMWA
PA88057OtherUNISON
PA8039952OtherTRICARE
PA480022261OtherRAILROAD MEDICARE
PA8039952OtherTRICARE