Provider Demographics
NPI:1699038208
Name:HANSELMAN, ANDREW EGON (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:EGON
Last Name:HANSELMAN
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 1:3000 ROGERS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5745
Mailing Address - Country:US
Mailing Address - Phone:919-385-1080
Mailing Address - Fax:919-385-1099
Practice Address - Street 1:3000 ROGERS RD STE 300
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5745
Practice Address - Country:US
Practice Address - Phone:919-385-1080
Practice Address - Fax:919-385-1099
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-01204207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery