1356399893 NPI number — MICHAEL M HANSEN MD

Table of content: MICHAEL M HANSEN MD (NPI 1356399893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356399893 NPI number — MICHAEL M HANSEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSEN
Provider First Name:
MICHAEL
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356399893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 J D ANDERSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26505-3494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-598-1200
Provider Business Mailing Address Fax Number:
304-598-1699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 J D ANDERSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-3494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-598-1330
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  MD 042196 E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: 34326 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0903240 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 75257000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012337780019 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012337780018 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00402890 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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