Healthcare Provider Details

I. General information

NPI: 1891996419
Provider Name (Legal Business Name): ERIC GLEN HANSEN ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 OLD EMMITSBURG RD
EMMITSBURG MD
21727-7700
US

IV. Provider business mailing address

12 OLD OAK PL
THURMONT MD
21788-1858
US

V. Phone/Fax

Practice location:
  • Phone: 301-447-5386
  • Fax: 301-447-6828
Mailing address:
  • Phone: 301-693-2832
  • Fax: 301-447-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: