Provider Demographics
NPI:1295920742
Name:THARWAT A HANNA MD PC
Entity type:Organization
Organization Name:THARWAT A HANNA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANI
Authorized Official - Middle Name:I
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-834-2068
Mailing Address - Street 1:435 FURNACE ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2328
Mailing Address - Country:US
Mailing Address - Phone:781-834-2068
Mailing Address - Fax:781-837-0244
Practice Address - Street 1:435 FURNACE ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2328
Practice Address - Country:US
Practice Address - Phone:781-834-2068
Practice Address - Fax:781-837-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM16520OtherBLUE CROSS BLUE SHIELD
MAJ14655OtherMEDICARE
MA9783601Medicaid