Healthcare Provider Details

I. General information

NPI: 1669049318
Provider Name (Legal Business Name): CRAIG WILLIAM HANNA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W RIVER ST STE 2A
PROVIDENCE RI
02904-2615
US

IV. Provider business mailing address

148 W RIVER ST STE 2A
PROVIDENCE RI
02904-2615
US

V. Phone/Fax

Practice location:
  • Phone: 401-616-1729
  • Fax: 401-727-1979
Mailing address:
  • Phone: 401-616-1729
  • Fax: 401-727-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number288460
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: