Provider Demographics
NPI:1164536397
Name:HANSON, CASEY S (MD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:S
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-0008
Mailing Address - Country:US
Mailing Address - Phone:207-667-5899
Mailing Address - Fax:207-667-0184
Practice Address - Street 1:390 BAR HARBOR RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:ME
Practice Address - Zip Code:04605-5807
Practice Address - Country:US
Practice Address - Phone:207-667-5899
Practice Address - Fax:207-667-0184
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD17174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMD17174OtherSTATE MD LICENSE
11615012OtherCAQH ID NUMBER
ME432383799Medicaid
11615012OtherCAQH ID NUMBER