Provider Demographics
NPI:1780637942
Name:HANNUSH, SADEER B (MD)
Entity Type:Individual
Prefix:DR
First Name:SADEER
Middle Name:B
Last Name:HANNUSH
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 1:400 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1819
Mailing Address - Country:US
Mailing Address - Phone:215-752-8564
Mailing Address - Fax:215-752-6968
Practice Address - Street 1:400 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1819
Practice Address - Country:US
Practice Address - Phone:215-752-8564
Practice Address - Fax:215-752-6968
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042711E204F00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA57059OtherAETNA
NJ232550551OtherHORIZON
PA428668OtherBLUE CROSS/BLUE SHIELD
PA0115036000OtherKEYSTONE HEALTH PLAN EAST
PA428668OtherBLUE CROSS/BLUE SHIELD
PA57059OtherAETNA