Provider Demographics
NPI:1952492688
Name:HANOWSKY, JEROME ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ALEXANDER
Last Name:HANOWSKY
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 1:2817 CROW CANYON RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1639
Mailing Address - Country:US
Mailing Address - Phone:925-820-8613
Mailing Address - Fax:
Practice Address - Street 1:2817 CROW CANYON RD STE 202
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1639
Practice Address - Country:US
Practice Address - Phone:925-820-8613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG202912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40889Medicare UPIN