Provider Demographics
NPI:1205816022
Name:HANNA, HAITHAM M (PA-C)
Entity Type:Individual
Prefix:
First Name:HAITHAM
Middle Name:M
Last Name:HANNA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10250 N 92ND ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4510
Mailing Address - Country:US
Mailing Address - Phone:480-237-5727
Mailing Address - Fax:480-657-3207
Practice Address - Street 1:10250 N 92ND ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4510
Practice Address - Country:US
Practice Address - Phone:480-237-5727
Practice Address - Fax:480-657-3207
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1922363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00351756OtherRAILROAD MEDICARE
AZ034060Medicaid
AZP00351756OtherRAILROAD MEDICARE