Provider Demographics
NPI:1598766057
Name:HANLON, ADA CAMEJO (MD)
Entity Type:Individual
Prefix:MRS
First Name:ADA
Middle Name:CAMEJO
Last Name:HANLON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1401 FORUM WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:561-242-0505
Mailing Address - Fax:561-242-9548
Practice Address - Street 1:1401 FORUM WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-242-0505
Practice Address - Fax:561-242-9548
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME68826208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251304800Medicaid