Provider Demographics
NPI:1063475184
Name:HANSON, THOMAS M (MD, FACOS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:HANSON
Suffix:
Gender:M
Credentials:MD, FACOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 TEMPLE ST
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510
Mailing Address - Country:US
Mailing Address - Phone:203-789-2011
Mailing Address - Fax:203-458-9063
Practice Address - Street 1:40 TEMPLE ST
Practice Address - Street 2:SUITE 7A
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-789-2011
Practice Address - Fax:203-458-9063
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT014549207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB39181Medicare UPIN