Provider Demographics
NPI:1225138910
Name:HANES, DOUGLAS J (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:HANES
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:ONE COOPER PLAZA
Mailing Address - Street 2:THE COOPER HOSPITALIST TEAM
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103
Mailing Address - Country:US
Mailing Address - Phone:856-342-3150
Mailing Address - Fax:856-968-8418
Practice Address - Street 1:ONE COOPER PLAZA
Practice Address - Street 2:THE COOPER HOSPITALIST TEAM
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103
Practice Address - Country:US
Practice Address - Phone:856-342-3150
Practice Address - Fax:856-968-8418
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA076558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
6954000OtherCIGNA
NJ0011398Medicaid
010005736 00OtherAMERICHOICE
1564910OtherPENNSYLVANIA BLUE SHIELD
60001855OtherHORIZON NJ HEALTH
P00082817OtherRR MEDICARE
2363398OtherUNITED HEALTHCARE
3352557OtherAETNA
P3083765OtherOXFORD
2245805000OtherAMERIHEALTH, KEYSTONE, IBC
38402OtherUNIVERSITY HEALTHPLAN
010005736 00OtherAMERICHOICE
2363398OtherUNITED HEALTHCARE