Healthcare Provider Details

I. General information

NPI: 1164536397
Provider Name (Legal Business Name): CASEY S HANSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASEY SMITH MD

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 BAR HARBOR RD
TRENTON ME
04605-5807
US

IV. Provider business mailing address

PO BOX 8
BAR HARBOR ME
04609-0008
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-5899
  • Fax: 207-801-5123
Mailing address:
  • Phone: 207-667-5899
  • Fax: 207-801-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD17174
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: