Provider Demographics
NPI:1376743872
Name:HAN, CALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:
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 1:16792 CONNEAUT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3748
Mailing Address - Country:US
Mailing Address - Phone:814-373-2335
Mailing Address - Fax:
Practice Address - Street 1:16792 CONNEAUT LAKE RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3748
Practice Address - Country:US
Practice Address - Phone:814-373-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245030207RH0003X
PAMD447581207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028445930001Medicaid
PA321235Medicare PIN