Provider Demographics
NPI:1881675999
Name:HANLEY, ALLISON W (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:W
Last Name:HANLEY
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 1:1803 PARK CENTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6216
Mailing Address - Country:US
Mailing Address - Phone:407-801-5001
Mailing Address - Fax:407-299-8999
Practice Address - Street 1:1803 PARK CENTER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6216
Practice Address - Country:US
Practice Address - Phone:407-801-5001
Practice Address - Fax:407-299-8999
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069749207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28914OtherBLUE CROSS PROVIDER #
FL28914VOtherMEDICARE PTAN - FL
FL250015900Medicaid
FLF67953Medicare UPIN