Provider Demographics
NPI:1346391729
Name:HANLON, ROBERT SAMUEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SAMUEL
Last Name:HANLON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 JOHN GLENN DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-1908
Mailing Address - Country:US
Mailing Address - Phone:610-383-5030
Mailing Address - Fax:
Practice Address - Street 1:76 JOHN GLENN DR
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-1908
Practice Address - Country:US
Practice Address - Phone:610-383-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001740L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA441480380OtherPALETTA GPA
PA2701432OtherEVERCARE
PA0050616401OtherAMERICHOICE
PA0005061640003Medicaid
NJ71809000Medicaid
PAHA73880OtherBLUE SHIELD
PA2701432OtherEVERCARE
PA0050616401OtherAMERICHOICE