Healthcare Provider Details

I. General information

NPI: 1780637942
Provider Name (Legal Business Name): SADEER B HANNUSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MIDDLETOWN BLVD SUITE 110
LANGHORNE PA
19047-1819
US

IV. Provider business mailing address

400 MIDDLETOWN BLVD SUITE 110
LANGHORNE PA
19047-1819
US

V. Phone/Fax

Practice location:
  • Phone: 215-752-8564
  • Fax: 215-752-6968
Mailing address:
  • Phone: 215-752-8564
  • Fax: 215-752-6968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberMD042711E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD042711E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: