Healthcare Provider Details

I. General information

NPI: 1134328537
Provider Name (Legal Business Name): WILLIAM HANNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4326 BAINTREE RD
CLEVELAND OH
44118-3931
US

IV. Provider business mailing address

4326 BAINTREE RD
CLEVELAND OH
44118-3931
US

V. Phone/Fax

Practice location:
  • Phone: 304-617-5206
  • Fax:
Mailing address:
  • Phone: 304-617-5206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number232920
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number35.097530
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: