Provider Demographics
NPI:1598944415
Name:GEBRE MEDHIN, HANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:HANNA
Middle Name:
Last Name:GEBRE MEDHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SUMMERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3275
Mailing Address - Country:US
Mailing Address - Phone:732-561-7810
Mailing Address - Fax:
Practice Address - Street 1:10A W RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831-6783
Practice Address - Country:US
Practice Address - Phone:732-561-7810
Practice Address - Fax:732-631-0742
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA076396002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0148695Medicaid
NJ1780866129OtherGROUP NPI IN WHICH MEDICAID IS REGISTERED UNDER
NJ261310737OtherEIN