Provider Demographics
NPI:1346234986
Name:OH-TAN, HANITA THERESE (MD)
Entity Type:Individual
Prefix:
First Name:HANITA
Middle Name:THERESE
Last Name:OH-TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HANITA
Other - Middle Name:THERESE
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:407 N. WASHINGTON STREET
Mailing Address - Street 2:STE. 100
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046
Mailing Address - Country:US
Mailing Address - Phone:703-237-5919
Mailing Address - Fax:703-241-1863
Practice Address - Street 1:407 N. WASHINGTON STREET
Practice Address - Street 2:STE. 100
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046
Practice Address - Country:US
Practice Address - Phone:703-237-5919
Practice Address - Fax:703-241-1863
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240083208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH89846Medicare UPIN