Provider Demographics
NPI:1205815768
Name:HANNA, THARWAT A (MD)
Entity Type:Individual
Prefix:DR
First Name:THARWAT
Middle Name:A
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 1:435 FURNACE ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050
Mailing Address - Country:US
Mailing Address - Phone:781-834-4234
Mailing Address - Fax:781-837-0244
Practice Address - Street 1:435 FURNACE ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050
Practice Address - Country:US
Practice Address - Phone:781-834-4234
Practice Address - Fax:781-837-0244
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9783601Medicaid
MAJ14655Medicare ID - Type Unspecified
F83330Medicare UPIN