Healthcare Provider Details

I. General information

NPI: 1245328723
Provider Name (Legal Business Name): CHRISTIAN THOMAS HANLEY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 W. PERIMETER RD
ANDREWS AFB MD
20762
US

IV. Provider business mailing address

132 SACORA LN
SUMMERVILLE SC
29483-2128
US

V. Phone/Fax

Practice location:
  • Phone: 240-857-5282
  • Fax:
Mailing address:
  • Phone: 301-580-9154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01056185A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number01056185A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: