Provider Demographics
NPI:1790872992
Name:HANNA, ADEL G (MD)
Entity Type:Individual
Prefix:
First Name:ADEL
Middle Name:G
Last Name:HANNA
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:PO BOX 494
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-0494
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5677 SCIOTO DARBY RD STE 200
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1368
Practice Address - Country:US
Practice Address - Phone:614-921-0648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-07
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-074329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2079790Medicaid
OHF89881Medicare UPIN
OHH022021Medicare PIN
OH2079790Medicaid