Provider Demographics
NPI:1902843170
Name:SHENGGAO HAN, M.D., LLC
Entity Type:Organization
Organization Name:SHENGGAO HAN, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SHENGGAO
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-463-3720
Mailing Address - Street 1:625 RUSTIC LODGE RD STE B
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3403
Mailing Address - Country:US
Mailing Address - Phone:724-463-3720
Mailing Address - Fax:
Practice Address - Street 1:625 RUSTIC LODGE RD STE B
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3403
Practice Address - Country:US
Practice Address - Phone:724-463-3720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010368600001Medicaid
PA1532898OtherHIGHMARK
PAX98639Medicare UPIN
PA1532898OtherHIGHMARK