Healthcare Provider Details

I. General information

NPI: 1689947780
Provider Name (Legal Business Name): M RENEE HANSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10512 WILLOWBROOK DR
POTOMAC MD
20854-4458
US

IV. Provider business mailing address

10512 WILLOWBROOK DR
POTOMAC MD
20854-4458
US

V. Phone/Fax

Practice location:
  • Phone: 301-299-3217
  • Fax: 301-983-9764
Mailing address:
  • Phone: 301-299-3217
  • Fax: 301-983-9764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0023398
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: