Provider Demographics
NPI:1700659919
Name:HANLIN, MARVIN GLEN JR
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:GLEN
Last Name:HANLIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 3RD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-3042
Mailing Address - Country:US
Mailing Address - Phone:304-790-5374
Mailing Address - Fax:
Practice Address - Street 1:87 3RD ST APT 2
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-3042
Practice Address - Country:US
Practice Address - Phone:304-790-5374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant