Provider Demographics
NPI:1376992990
Name:YAN, HENRY HUANDONG (PA-C)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:HUANDONG
Last Name:YAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:HUANDONG
Other - Middle Name:
Other - Last Name:YAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1645 LIBERTY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6521
Mailing Address - Country:US
Mailing Address - Phone:410-795-3747
Mailing Address - Fax:410-795-3795
Practice Address - Street 1:3317 PENN AVE
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1436
Practice Address - Country:US
Practice Address - Phone:610-750-7891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant