Provider Demographics
NPI:1275585481
Name:HANNA, SOPHIE S (MD)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:S
Last Name:HANNA
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 1:943 ROUTE 228
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-2325
Mailing Address - Country:US
Mailing Address - Phone:724-591-5583
Mailing Address - Fax:724-591-5563
Practice Address - Street 1:943 ROUTE 228
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-2325
Practice Address - Country:US
Practice Address - Phone:724-591-5583
Practice Address - Fax:724-591-5563
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-4255602081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101660063 0002Medicaid
PA157764 ZD66Medicare PIN
PA101660063 0002Medicaid