Provider Demographics
NPI:1386855542
Name:BERNICE HOANGLAN DOAN
Entity Type:Organization
Organization Name:BERNICE HOANGLAN DOAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:HOANGLAN
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-409-2919
Mailing Address - Street 1:172 DEER RUN DR
Mailing Address - Street 2:
Mailing Address - City:TROUTMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28166-7653
Mailing Address - Country:US
Mailing Address - Phone:800-409-2919
Mailing Address - Fax:215-393-0809
Practice Address - Street 1:557 BROOKDALE DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-4107
Practice Address - Country:US
Practice Address - Phone:800-409-2919
Practice Address - Fax:215-393-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-26
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty