Provider Demographics
NPI:1417906520
Name:HANNAN, MOHAMMED A (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:A
Last Name:HANNAN
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 87507
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3666
Mailing Address - Country:US
Mailing Address - Phone:910-484-5366
Mailing Address - Fax:910-223-0583
Practice Address - Street 1:2149 VALLEYGATE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3666
Practice Address - Country:US
Practice Address - Phone:910-484-5366
Practice Address - Fax:910-223-0583
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99-00524207R00000X
NC9900524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912114Medicaid
NC8912114Medicaid
NC22759108Medicare PIN