Provider Demographics
NPI:1346357951
Name:HANNULA, TODD T (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:T
Last Name:HANNULA
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 1:1616 N MAIN ST
Mailing Address - Street 2:STE 100A
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4473
Mailing Address - Country:US
Mailing Address - Phone:276-783-9752
Mailing Address - Fax:276-783-7786
Practice Address - Street 1:1616 N MAIN ST
Practice Address - Street 2:STE 100A
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4473
Practice Address - Country:US
Practice Address - Phone:276-783-9752
Practice Address - Fax:276-783-7786
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39663207X00000X
VA0101252921207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1346357951Medicaid
WI32039700Medicaid
VAVV7976AMedicare PIN
F84500Medicare UPIN
VAC09112Medicare UPIN
680800040Medicare PIN