Provider Demographics
NPI:1013996917
Name:HANSEN, SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:HANSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 CATAWBA HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CATAWBA
Mailing Address - State:VA
Mailing Address - Zip Code:24070-2115
Mailing Address - Country:US
Mailing Address - Phone:540-375-4262
Mailing Address - Fax:540-375-4249
Practice Address - Street 1:5525 CATAWBA HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CATAWBA
Practice Address - State:VA
Practice Address - Zip Code:24070-2115
Practice Address - Country:US
Practice Address - Phone:540-375-4262
Practice Address - Fax:540-375-4249
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050235207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G96984Medicare UPIN