Provider Demographics
NPI:1265431878
Name:HANRAHAN, DAVID MICHAEL (RPA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:HANRAHAN
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727-1317
Mailing Address - Country:US
Mailing Address - Phone:585-968-2000
Mailing Address - Fax:585-968-2227
Practice Address - Street 1:140 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1317
Practice Address - Country:US
Practice Address - Phone:585-968-2000
Practice Address - Fax:585-968-2227
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006968363A00000X
NY6968363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000006369OtherBCBS CENTRAL PIN
NYP00000205282OtherGHI-FHP PIN
NYP019006968OtherBLUE CHOICE PIN
NY000915843003OtherBCBS WESTERN PIN
NY2589781OtherGHI PIN
NY01981286Medicaid
NY109744OtherPREFERRED CARE PIN
NY00027167502OtherUNIVERA PIN
NYBA0650Medicare PIN
NY00027167502OtherUNIVERA PIN
NYPA1016Medicare ID - Type Unspecified
NYO1981286Medicaid
NYJ40003963Medicare PIN