Provider Demographics
NPI:1306823489
Name:HANNA, EZZAT A (MD)
Entity Type:Individual
Prefix:
First Name:EZZAT
Middle Name:A
Last Name:HANNA
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:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HIGH BLVD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19607-2155
Practice Address - Country:US
Practice Address - Phone:610-775-2799
Practice Address - Fax:610-775-3284
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038616L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01395901OtherCAPITAL BLUE CROSS
PA020274OtherHIGHMARK BLUE SHIELD
PA101933939Medicaid
E52197Medicare UPIN
PA101933939Medicaid