Healthcare Provider Details

I. General information

NPI: 1467447730
Provider Name (Legal Business Name): ROBERT HANNON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 EAST ST
METHUEN MA
01844-4597
US

IV. Provider business mailing address

PO BOX 9135 ATT: SHARON SILVA
BROOKLINE MA
02446-9135
US

V. Phone/Fax

Practice location:
  • Phone: 978-682-3004
  • Fax:
Mailing address:
  • Phone: 800-927-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number37890
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5544
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2032589
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
Identifier81303244
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: