Provider Demographics
NPI:1235255787
Name:CHRISTOPHER J HANLON, MD, PLLC
Entity Type:Organization
Organization Name:CHRISTOPHER J HANLON, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HANLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-650-0414
Mailing Address - Street 1:10645 N TATUM BLVD
Mailing Address - Street 2:SUITE 200-241
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10645 N TATUM BLVD
Practice Address - Street 2:SUITE 200-241
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3068
Practice Address - Country:US
Practice Address - Phone:516-650-0414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45561207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05577Medicare ID - Type UnspecifiedGHI MEDICARE
NYW37151Medicare ID - Type UnspecifiedEMPIRE MEDICARE