Healthcare Provider Details

I. General information

NPI: 1619911609
Provider Name (Legal Business Name): LARRY STEVEN HAHN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 E STREET RD
TREVOSE PA
19053-7711
US

IV. Provider business mailing address

339 E STREET RD
TREVOSE PA
19053-7711
US

V. Phone/Fax

Practice location:
  • Phone: 267-574-8100
  • Fax: 267-574-8111
Mailing address:
  • Phone: 267-574-8100
  • Fax: 267-574-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS004862L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: