Provider Demographics
NPI:1700848363
Name:HANNAH, CARL ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:ROBERT
Last Name:HANNAH
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 1:6 HICKOK ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3524
Mailing Address - Country:US
Mailing Address - Phone:540-383-6148
Mailing Address - Fax:540-382-4191
Practice Address - Street 1:6 HICKOK ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3524
Practice Address - Country:US
Practice Address - Phone:540-383-6148
Practice Address - Fax:540-382-4191
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010098891Medicaid
VA144661OtherANTHEM PROVIDER NUMBER
VA010098891OtherVIRGINIA PREMIER
VA2065534OtherUNITED HEALTHCARE
VA245710OtherSOUTHERN HEALTH PROVIDER
VA3131709OtherMAMSI PROVIDER NUMBER
VA1700848363Medicaid
VA5389156OtherAETNA PROVIDER NUMBER
VA7161454OtherCIGNA PROVIDER NUMBER
VIP00240702OtherMEDICARE RAILROAD
VA2065534OtherUNITED HEALTHCARE
VA1700848363Medicaid
VA5389156OtherAETNA PROVIDER NUMBER
VA005700C93Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER