Provider Demographics
NPI:1902846645
Name:HANSEN, ZACHARY HENRY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:HENRY LEE
Last Name:HANSEN
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 1:1600 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3656
Mailing Address - Country:US
Mailing Address - Phone:304-691-1100
Mailing Address - Fax:
Practice Address - Street 1:800 20TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1850
Practice Address - Country:US
Practice Address - Phone:304-696-8700
Practice Address - Fax:304-696-8701
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001709560OtherMT. STATE
WV3810005341Medicaid
WV00427034OtherRR MEDICARE
OH2657807Medicaid
KY64127509Medicaid
WVI55379Medicare UPIN
WV2027532Medicare PIN
WV2027537Medicare PIN
WVWV2182A , WV2182BMedicare PIN
WV001709560OtherMT. STATE
WV3810005341Medicaid
KY64127509Medicaid
WV00427034OtherRR MEDICARE
OH2657807Medicaid
WV2027536Medicare PIN