Provider Demographics
NPI:1679573257
Name:HANSON, CHARLES D (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:D
Last Name:HANSON
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 1:52 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-4406
Mailing Address - Country:US
Mailing Address - Phone:207-866-0408
Mailing Address - Fax:207-989-5743
Practice Address - Street 1:52 PARK ST
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-4406
Practice Address - Country:US
Practice Address - Phone:207-866-0408
Practice Address - Fax:207-989-5743
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0145842084P0800X
NH118492084P0800X
MA740772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3165493Medicaid
F71815Medicare UPIN
MA3165493Medicaid