Provider Demographics
NPI:1760097869
Name:HAHN, ROBERT CLYDE JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CLYDE
Last Name:HAHN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5248 LONDON LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-9783
Mailing Address - Country:US
Mailing Address - Phone:614-558-7241
Mailing Address - Fax:
Practice Address - Street 1:5248 LONDON LANCASTER RD
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9783
Practice Address - Country:US
Practice Address - Phone:614-558-7241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide