Healthcare Provider Details

I. General information

NPI: 1962425579
Provider Name (Legal Business Name): MICHELLE ANNE HANKINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE HO/111
BOSTON MA
02130-4817
US

IV. Provider business mailing address

150 S HUNTINGTON AVE HO/111
BOSTON MA
02130-4817
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-5415
  • Fax: 617-738-1450
Mailing address:
  • Phone: 857-364-5415
  • Fax: 617-738-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number79779
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: