Provider Demographics
NPI:1891996419
Name:HANSEN, ERIC GLEN (ATC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:GLEN
Last Name:HANSEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OLD OAK PL
Mailing Address - Street 2:
Mailing Address - City:THURMONT
Mailing Address - State:MD
Mailing Address - Zip Code:21788-1858
Mailing Address - Country:US
Mailing Address - Phone:301-693-2832
Mailing Address - Fax:301-447-6828
Practice Address - Street 1:16300 OLD EMMITSBURG RD
Practice Address - Street 2:
Practice Address - City:EMMITSBURG
Practice Address - State:MD
Practice Address - Zip Code:21727-7700
Practice Address - Country:US
Practice Address - Phone:301-447-5386
Practice Address - Fax:301-447-6828
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist