Provider Demographics
NPI:1235190927
Name:HANLON, ALBERT A (PA)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:A
Last Name:HANLON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:STE 110
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4540
Mailing Address - Country:US
Mailing Address - Phone:781-396-4514
Mailing Address - Fax:781-395-4778
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:STE 110
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4540
Practice Address - Country:US
Practice Address - Phone:781-396-4514
Practice Address - Fax:781-395-4778
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA666363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP26170Medicare UPIN