Provider Demographics
NPI:1801898572
Name:HANNA, JAMES ROBERT (DPM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:HANNA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5338
Mailing Address - Country:US
Mailing Address - Phone:716-433-8711
Mailing Address - Fax:716-433-8705
Practice Address - Street 1:690 DAVISON RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5338
Practice Address - Country:US
Practice Address - Phone:716-433-8711
Practice Address - Fax:716-433-8705
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-10-30
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NYN005077213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01578734Medicaid
NYRA2372Medicare PIN
NY01578734Medicaid
NY5105140001Medicare NSC