Healthcare Provider Details

I. General information

NPI: 1801990197
Provider Name (Legal Business Name): HOLLY C HANNON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 27TH ST STE 102
PORTSMOUTH OH
45662-2679
US

IV. Provider business mailing address

1735 27TH ST STE B06
PORTSMOUTH OH
45662-2681
US

V. Phone/Fax

Practice location:
  • Phone: 740-356-8822
  • Fax: 740-356-8872
Mailing address:
  • Phone: 740-356-8681
  • Fax: 740-356-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number35.130412
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: