Provider Demographics
NPI:1790336659
Name:HANAU, ALICIA ROBIN (PA-C)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ROBIN
Last Name:HANAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY STREET, SUITE 3A
Practice Address - Street 2:SHAPIRO BLDG.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-8419
Practice Address - Fax:617-414-0201
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2024-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPA7252363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110157396AMedicaid
NH3139761Medicaid