Provider Demographics
NPI:1831181304
Name:HAHN, JERRY MITCHELL (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:MITCHELL
Last Name:HAHN
Suffix:
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 1:2076 STACKS GAP RD
Mailing Address - Street 2:
Mailing Address - City:WARDENSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26851
Mailing Address - Country:US
Mailing Address - Phone:304-822-3838
Mailing Address - Fax:304-822-7665
Practice Address - Street 1:RT 50 EAST
Practice Address - Street 2:SUNRISE PROFESSIONAL BUILDING
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757
Practice Address - Country:US
Practice Address - Phone:304-822-3838
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15226207NS0135X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVC62956Medicare UPIN
WV0640433Medicare ID - Type Unspecified