Provider Demographics
NPI:1275791071
Name:STEVAN T HANNA MD LTD
Entity Type:Organization
Organization Name:STEVAN T HANNA MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-885-8161
Mailing Address - Street 1:PO BOX 2157
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24402-2157
Mailing Address - Country:US
Mailing Address - Phone:540-885-8161
Mailing Address - Fax:540-886-6397
Practice Address - Street 1:13 TERRY ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2562
Practice Address - Country:US
Practice Address - Phone:540-885-8161
Practice Address - Fax:540-886-6397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101020572207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006571310Medicaid
VAGC1001Medicare PIN
VAB07777Medicare UPIN