Basic Information
| Provider Information | |||||||||
| NPI: | 1700890985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANLEY | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 601372 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282601372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043555982 | ||||||||
| FaxNumber: | 7043555984 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 MOREHEAD MEDICAL DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282042963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043555982 | ||||||||
| FaxNumber: | 7043555984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 12/06/2016 | ||||||||
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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 | 207X00000X | 000037845 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0117X | 37845 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 39054 | 01 | NC | NCBCBS | OTHER | N37845 | 05 | SC | MEDICAID | 8939054 | 05 | NC | MEDICAID | 1700890985 | 05 | NC | MEDICAID |