Provider Demographics
NPI:1164540308
Name:HANSON, JOHN SANGER (LIC AC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SANGER
Last Name:HANSON
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-0238
Mailing Address - Country:US
Mailing Address - Phone:301-475-8688
Mailing Address - Fax:
Practice Address - Street 1:22780 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-1538
Practice Address - Country:US
Practice Address - Phone:301-737-0662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00633171100000X
MA281171100000X
VA0121000374171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS477-0001OtherCAREFIRST BLUECROSSBLUESH
MDBL08JSOtherCAREFIRST BLUECROSS BLUES