Provider Demographics
NPI:1730146606
Name:HAN, ENOCH DAVID (MD)
Entity type:Individual
Prefix:
First Name:ENOCH
Middle Name:DAVID
Last Name:HAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:C
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:155 WELLNESS WAY
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6797
Mailing Address - Country:US
Mailing Address - Phone:814-231-7000
Mailing Address - Fax:814-231-7098
Practice Address - Street 1:1850 E PARK AVE STE 201
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6706
Practice Address - Country:US
Practice Address - Phone:814-689-3140
Practice Address - Fax:814-234-0491
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0688602L2086S0129X
PAMD068602L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017572020004Medicaid
PA028395Medicare PIN
PA0017572020004Medicaid