Provider Demographics
NPI:1255341152
Name:HANNAN, EDWARD JOSPEH (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOSPEH
Last Name:HANNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 BURDETT AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2447
Mailing Address - Country:US
Mailing Address - Phone:518-272-0171
Mailing Address - Fax:517-271-6580
Practice Address - Street 1:2231 BURDETT AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2447
Practice Address - Country:US
Practice Address - Phone:518-272-0171
Practice Address - Fax:517-271-6580
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY160806208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00890042Medicaid
B82626Medicare UPIN
NY00890042Medicaid