Provider Demographics
NPI:1003976200
Name:HANAHAN, PAUL CANNING (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CANNING
Last Name:HANAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 TURNEY RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-9773
Mailing Address - Country:US
Mailing Address - Phone:440-259-5550
Mailing Address - Fax:
Practice Address - Street 1:50 NORMANDY DR STE 5
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1600
Practice Address - Country:US
Practice Address - Phone:440-354-4747
Practice Address - Fax:440-354-3530
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH39750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0492631Medicaid
OHC02062Medicare UPIN
OH0492631Medicaid