Healthcare Provider Details

I. General information

NPI: 1720173081
Provider Name (Legal Business Name): THOMAS ANDREW HANNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5856 SCENIC AVE
MEXICO NY
13114-3013
US

IV. Provider business mailing address

5856 SCENIC AVE
MEXICO NY
13114-3013
US

V. Phone/Fax

Practice location:
  • Phone: 315-963-4133
  • Fax: 315-963-4960
Mailing address:
  • Phone: 315-963-4133
  • Fax: 315-963-4960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number204979
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: