Provider Demographics
NPI:1003105768
Name:HANSEN, DAVID WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:725 EAST ADAMS ST
Mailing Address - Street 2:5TH FL
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-464-5726
Mailing Address - Fax:315-464-2510
Practice Address - Street 1:3229 E. GENESEE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214
Practice Address - Country:US
Practice Address - Phone:315-464-5726
Practice Address - Fax:315-464-2510
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI60409208000000X
IN01075810A2080P0205X
NY2921932080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1003105768Medicaid
NY05233927Medicaid
IN1003105768Medicaid