Basic Information
| Provider Information | |||||||||
| NPI: | 1437370012 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANNAN | ||||||||
| FirstName: | HASHIBUL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 GILL STREET | ||||||||
| Address2: | SUITE 3000 | ||||||||
| City: | WOBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819374545 | ||||||||
| FaxNumber: | 7819374510 | ||||||||
| Practice Location | |||||||||
| Address1: | 504 SOUTH 54TH STREET | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157489000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 05/27/2008 | ||||||||
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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 | 207P00000X | MD431359 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 101901819 | 05 | PA | MEDICAID | 1963850 | 01 | PA | HIGHMARK BS | OTHER | 1019018190001 | 01 | PA | PROMISE | OTHER | 30045448 | 01 | PA | KEYSTONE MERCY | OTHER | 2844498000 | 01 | PA | KEYSTONE | OTHER | 1963850 | 01 | PA | BCBS | OTHER |