Provider Demographics
NPI:1144223355
Name:HA, HANNAH-NGOC T (MD)
Entity Type:Individual
Prefix:
First Name:HANNAH-NGOC
Middle Name:T
Last Name:HA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12401 OLIVE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5448
Mailing Address - Country:US
Mailing Address - Phone:314-834-2888
Mailing Address - Fax:314-834-5212
Practice Address - Street 1:12401 OLIVE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-5448
Practice Address - Country:US
Practice Address - Phone:314-834-2888
Practice Address - Fax:314-834-5212
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2001028190208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH49840Medicare UPIN