Provider Demographics
NPI:1932133386
Name:HANNA, MATTHEW T (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:HANNA
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 1:108 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2550
Mailing Address - Country:US
Mailing Address - Phone:207-386-1800
Mailing Address - Fax:207-442-9822
Practice Address - Street 1:108 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2550
Practice Address - Country:US
Practice Address - Phone:207-386-1800
Practice Address - Fax:207-442-9822
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10902713OtherCAQH
10902713OtherCAQH
G68059Medicare UPIN