Provider Demographics
NPI:1619969227
Name:HANSEN, ROBERT BLAINE (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BLAINE
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6275 E VIRGINIA BEACH BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2851
Mailing Address - Country:US
Mailing Address - Phone:757-461-3141
Mailing Address - Fax:757-461-1658
Practice Address - Street 1:6275 E VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2851
Practice Address - Country:US
Practice Address - Phone:757-461-3141
Practice Address - Fax:757-461-1658
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010414672084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01927504Medicaid
54-1951442OtherAETNA
NC890593RMedicaid
15005OtherSENTRA PPO
VA150684200OtherOWCP FED WC VIA ACS
VA265200OtherBCBS
265200OtherPRIORITY HEALTH CARE INC
VA130020497OtherMEDICARE RAILROAD
15005OtherSENTRA
265200OtherPENINSULA HEALTHCARE INC
64452OtherMEDCOST
265200OtherHEALTHKEEPERS
54-1951442OtherCORVEL WC PROVIDER NETWOR
VA54-1951442OtherHEALTH NETWORK
3336466004OtherCIGNA
VA7112378Medicaid
265200OtherANTHEM
VA7112378OtherPREMIER HEALTH PLAN
VA7112378Medicaid
3336466004OtherCIGNA