Provider Demographics
NPI:1205856952
Name:HANSCOM, JANE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:L
Last Name:HANSCOM
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 1:2440 M ST NW
Mailing Address - Street 2:STE 326
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1404
Mailing Address - Country:US
Mailing Address - Phone:202-457-0606
Mailing Address - Fax:202-457-0694
Practice Address - Street 1:2440 M ST NW
Practice Address - Street 2:STE 326
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1404
Practice Address - Country:US
Practice Address - Phone:202-457-0606
Practice Address - Fax:202-457-0694
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD6098208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1205856952Medicaid
VA437714ZEUYMedicare PIN
DCB94963Medicare UPIN
P00763545Medicare PIN