Healthcare Provider Details

I. General information

NPI: 1285830554
Provider Name (Legal Business Name): BRIAN ROGER HANEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 TOPSHAM FAIR MALL RD UNIT 1
TOPSHAM ME
04086
US

IV. Provider business mailing address

PO BOX 911
BRATTLEBORO VT
05302-0911
US

V. Phone/Fax

Practice location:
  • Phone: 207-303-3300
  • Fax: 207-250-2137
Mailing address:
  • Phone: 207-303-3200
  • Fax: 207-303-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2047
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number20259
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: