Healthcare Provider Details

I. General information

NPI: 1346231578
Provider Name (Legal Business Name): MICHAEL SANFORD HANAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN ST WACC-812
BOSTON MA
02114-3117
US

IV. Provider business mailing address

28 HAMPTON RD
WESTWOOD MA
02090-2426
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-6300
  • Fax: 617-727-7541
Mailing address:
  • Phone: 781-461-8779
  • Fax: 617-726-7541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number151465
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: