Provider Demographics
NPI:1205839008
Name:PEARCE, HANNAH PHILLIPS (MD)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:PHILLIPS
Last Name:PEARCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 BERKMAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901
Mailing Address - Country:US
Mailing Address - Phone:434-923-4651
Mailing Address - Fax:434-964-3636
Practice Address - Street 1:3350 BERKMAR DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901
Practice Address - Country:US
Practice Address - Phone:434-923-4651
Practice Address - Fax:434-964-3636
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054281174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA542013472OtherTAX ID #
VA010218039Medicaid
VA181058OtherANTHEM HEALTHKEEPERS
VA31710300001OtherSOUTHERN HEALTH
VA181058OtherANTHEM BC/BS
VA31710300001OtherSOUTHERN HEALTH
VA008183A67Medicare ID - Type UnspecifiedMEDICARE