Provider Demographics
NPI:1437370012
Name:HANNAN, HASHIBUL (MD)
Entity Type:Individual
Prefix:
First Name:HASHIBUL
Middle Name:
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 1:12 GILL STREET
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801
Mailing Address - Country:US
Mailing Address - Phone:781-937-4545
Mailing Address - Fax:781-937-4510
Practice Address - Street 1:504 SOUTH 54TH STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143
Practice Address - Country:US
Practice Address - Phone:215-748-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431359207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101901819Medicaid
PA1963850OtherHIGHMARK BS
PA1019018190001OtherPROMISE
PA30045448OtherKEYSTONE MERCY
PA2844498000OtherKEYSTONE
PA1963850OtherBCBS
PA2844498000OtherKEYSTONE
PA1019018190001OtherPROMISE