Provider Demographics
NPI:1245328723
Name:HANLEY, CHRISTIAN THOMAS JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:THOMAS
Last Name:HANLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:132 SACORA LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-2128
Mailing Address - Country:US
Mailing Address - Phone:301-580-9154
Mailing Address - Fax:
Practice Address - Street 1:1075 W. PERIMETER RD
Practice Address - Street 2:
Practice Address - City:ANDREWS AFB
Practice Address - State:MD
Practice Address - Zip Code:20762
Practice Address - Country:US
Practice Address - Phone:240-857-5282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056185A207Q00000X, 2083A0100X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No171100000XOther Service ProvidersAcupuncturist