Provider Demographics
NPI:1891795696
Name:HANSING, JERALD D (MD)
Entity Type:Individual
Prefix:
First Name:JERALD
Middle Name:D
Last Name:HANSING
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 1:1735 FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3106
Mailing Address - Country:US
Mailing Address - Phone:740-354-1919
Mailing Address - Fax:740-354-1919
Practice Address - Street 1:1735 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3106
Practice Address - Country:US
Practice Address - Phone:740-354-1919
Practice Address - Fax:740-354-1919
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350474702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0489896Medicaid
KY64781347Medicaid
OHP00181880OtherSOM RR MDCR PIN NUMBER
E77888Medicare UPIN
OH0489896Medicaid
KY64781347Medicaid