Provider Demographics
NPI:1417957838
Name:HANSEN, GERALD J III (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:J
Last Name:HANSEN
Suffix:III
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 1:500 YORK RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2852
Mailing Address - Country:US
Mailing Address - Phone:215-481-2725
Mailing Address - Fax:
Practice Address - Street 1:500 YORK RD
Practice Address - Street 2:SUITE 108
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2852
Practice Address - Country:US
Practice Address - Phone:215-481-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 032607E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010587850013Medicaid
PA181034Medicare PIN
PAC32930Medicare UPIN