Provider Demographics
NPI:1619911609
Name:HAHN, LARRY STEVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:STEVEN
Last Name:HAHN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 E STREET RD
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7711
Mailing Address - Country:US
Mailing Address - Phone:267-574-8100
Mailing Address - Fax:267-574-8111
Practice Address - Street 1:339 E STREET RD
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7711
Practice Address - Country:US
Practice Address - Phone:267-574-8100
Practice Address - Fax:267-574-8111
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004862L207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0894842Medicaid
PA197662OtherBLUE SHIELD
PA0894842Medicaid
PA197662E2HMedicare ID - Type Unspecified