Healthcare Provider Details

I. General information

NPI: 1508003294
Provider Name (Legal Business Name): MARY HELEN HANESSIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY HELEN KENNY

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HOSPITAL DR
ATHENS OH
45701-2301
US

IV. Provider business mailing address

90 HOSPITAL DR
ATHENS OH
45701-2301
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-3682
  • Fax: 740-593-8659
Mailing address:
  • Phone: 740-593-3682
  • Fax: 740-593-8659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35-127047
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: