Provider Demographics
NPI:1073555819
Name:HANNA, SALIM W (MD)
Entity Type:Individual
Prefix:DR
First Name:SALIM
Middle Name:W
Last Name:HANNA
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 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-998-4575
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:1005 BELLEFONTAINE AVE STE 340
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2876
Practice Address - Country:US
Practice Address - Phone:419-227-3077
Practice Address - Fax:419-224-1667
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0818818OtherMEDICARE NUMBER
OH2024679Medicaid
OH000000141879OtherANTHEM
OH2024679Medicaid
OH0818818OtherMEDICARE NUMBER
OHHA0818818Medicare PIN