Provider Demographics
NPI:1104827609
Name:JAMES R. HANNA DPM PC
Entity Type:Organization
Organization Name:JAMES R. HANNA DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-433-8711
Mailing Address - Street 1:690 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5338
Mailing Address - Country:US
Mailing Address - Phone:716-433-8711
Mailing Address - Fax:716-433-8705
Practice Address - Street 1:690 DAVISON RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5338
Practice Address - Country:US
Practice Address - Phone:716-433-8711
Practice Address - Fax:716-433-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005077213E00000X
213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01578734Medicaid
NYBA0204Medicare PIN
NY01578734Medicaid
NYY13245Medicare UPIN