Healthcare Provider Details

I. General information

NPI: 1982181905
Provider Name (Legal Business Name): MARTIN HANSON MBBS, FRACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 RAY C HUNT DR STE 2200
CHARLOTTESVILLE VA
22903-2980
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5700
  • Fax: 434-924-1736
Mailing address:
  • Phone: 434-295-1000
  • Fax: 434-972-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberP10641
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: