Provider Demographics
NPI:1386636926
Name:HANRAHAN, L ROBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:L
Middle Name:ROBERT
Last Name:HANRAHAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:BRODY OUTPATIENT CENTER
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-744-2207
Practice Address - Fax:252-744-3616
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC22121207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC39080OtherBCBS NC
NC8939080Medicaid
NCG21412Medicare UPIN
NC39080OtherBCBS NC