Provider Demographics
NPI:1477607109
Name:HAN, CHRISTIAN TAE HO (MPT)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:TAE HO
Last Name:HAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8492 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:STE 207
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3378
Mailing Address - Country:US
Mailing Address - Phone:301-776-0421
Mailing Address - Fax:301-598-7432
Practice Address - Street 1:3836 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-1548
Practice Address - Country:US
Practice Address - Phone:301-598-7420
Practice Address - Fax:301-598-7432
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20173225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD338063OtherMAMSI LIFE MD IPA
MD683203200OtherAMERIGROUP
MDLK24ATOtherCF BLUE CROSS BLUE SHIELD
DCS9860005OtherCF BLUE CROSS BLUE SHIELD
MD4039165Medicaid
MDG02228A02Medicare ID - Type UnspecifiedHOME THERAPY
MD4039165Medicaid