Provider Demographics
NPI:1598766818
Name:HANLAN, DERICK ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:DERICK
Middle Name:ANTHONY
Last Name:HANLAN
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 1:891 LINGANORE DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2143
Mailing Address - Country:US
Mailing Address - Phone:703-558-6284
Mailing Address - Fax:703-558-5512
Practice Address - Street 1:1701 N GEORGE MASON DR
Practice Address - Street 2:RADIATION ONCOLOGY DEPT
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3610
Practice Address - Country:US
Practice Address - Phone:703-558-6284
Practice Address - Fax:703-558-5512
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010319792085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7276192Medicaid
VAC-88482Medicare UPIN
VA083906Medicare ID - Type Unspecified