Provider Demographics
NPI:1851787824
Name:HANNAN, MARY KATHRYN (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:HANNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHRYN HANNAN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:RED TEAM PRIMARY CARE
Mailing Address - Street 2:50 IRVING STREET NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20422
Mailing Address - Country:US
Mailing Address - Phone:202-745-8000
Mailing Address - Fax:202-518-4880
Practice Address - Street 1:RED TEAM PRIMARY CARE
Practice Address - Street 2:50 IRVING STREET NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422
Practice Address - Country:US
Practice Address - Phone:202-745-8000
Practice Address - Fax:202-518-4880
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA276673207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program