Provider Demographics
NPI:1396728549
Name:HANSEN, LORI L (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 HORSESHOE FARM RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:VA
Mailing Address - Zip Code:24136-3478
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2829 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:NARROWS
Practice Address - State:VA
Practice Address - Zip Code:24124-2369
Practice Address - Country:US
Practice Address - Phone:540-726-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-229022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005646901Medicaid
VA005646910Medicaid
H34346Medicare PIN
VA017925C18Medicare PIN
VAH34346Medicare UPIN
001580C23Medicare PIN