1700848363 NPI number — DR. CARL ROBERT HANNAH M.D

Table of content: DR. CARL ROBERT HANNAH M.D (NPI 1700848363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700848363 NPI number — DR. CARL ROBERT HANNAH M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANNAH
Provider First Name:
CARL
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
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:
1700848363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 HICKOK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHRISTIANSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24073-3524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-383-6148
Provider Business Mailing Address Fax Number:
540-382-4191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 HICKOK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHRISTIANSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24073-3524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-383-6148
Provider Business Practice Location Address Fax Number:
540-382-4191
Provider Enumeration Date:
04/06/2006

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: 207Q00000X , with the licence number:  0101235860 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010098891 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 144661 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010098891 . This is a "VIRGINIA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2065534 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 245710 . This is a "SOUTHERN HEALTH PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3131709 . This is a "MAMSI PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1700848363 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5389156 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7161454 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00240702 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".




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