Provider Demographics
NPI:1700890985
Name:HANLEY, EDWARD N JR (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:N
Last Name:HANLEY
Suffix:JR
Gender:M
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:PO BOX 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-355-5982
Mailing Address - Fax:704-355-5984
Practice Address - Street 1:1025 MOREHEAD MEDICAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2963
Practice Address - Country:US
Practice Address - Phone:704-355-5982
Practice Address - Fax:704-355-5984
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000037845207X00000X
NC37845207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC39054OtherNCBCBS
SCN37845Medicaid
NC8939054Medicaid
NC1700890985Medicaid
NC39054OtherNCBCBS
NC1700890985Medicaid
SCN37845Medicaid
NCB37501Medicare UPIN