Provider Demographics
NPI:1629091228
Name:HANSEN, CHRISTOPHER L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:L
Last Name:HANSEN
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 1:925 CHESTNUT STREET
Mailing Address - Street 2:MEZZANINE FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4201
Mailing Address - Country:US
Mailing Address - Phone:215-955-5050
Mailing Address - Fax:215-955-7499
Practice Address - Street 1:925 CHESTNUT ST
Practice Address - Street 2:MEZZANINE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4216
Practice Address - Country:US
Practice Address - Phone:215-955-5050
Practice Address - Fax:215-955-7499
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038595E207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001089370Medicaid
NJ6008101Medicaid
PA154752Medicare PIN