Healthcare Provider Details

I. General information

NPI: 1164540308
Provider Name (Legal Business Name): JOHN SANGER HANSON LIC. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22780 THREE NOTCH RD
LEXINGTON PARK MD
20653-1538
US

IV. Provider business mailing address

PO BOX 238
LEONARDTOWN MD
20650-0238
US

V. Phone/Fax

Practice location:
  • Phone: 301-737-0662
  • Fax:
Mailing address:
  • Phone: 301-475-8688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU00633
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number281
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000374
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: