Basic Information
| Provider Information | |||||||||
| NPI: | 1265431878 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANRAHAN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | RPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CUBA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147271317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859682000 | ||||||||
| FaxNumber: | 5859682227 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CUBA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147271317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859682000 | ||||||||
| FaxNumber: | 5859682227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 07/06/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 006968 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 00027167502 | 01 | NY | UNIVERA PIN | OTHER | 000006369 | 01 | NY | BCBS CENTRAL PIN | OTHER | 109744 | 01 | NY | PREFERRED CARE PIN | OTHER | 2589781 | 01 | NY | GHI PIN | OTHER | P00000205282 | 01 | NY | GHI-FHP PIN | OTHER | 000915843003 | 01 | NY | BCBS WESTERN PIN | OTHER | O1981286 | 05 | NY | MEDICAID | P019006968 | 01 | NY | BLUE CHOICE PIN | OTHER |