Healthcare Provider Details

I. General information

NPI: 1265450498
Provider Name (Legal Business Name): WILLIAM PAUL HANNAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2342
US

IV. Provider business mailing address

750 E ADAMS ST
SYRACUSE NY
13210-2342
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5450
  • Fax: 315-464-5853
Mailing address:
  • Phone: 315-464-5450
  • Fax: 315-464-5853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number159129
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number159129
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: