Healthcare Provider Details

I. General information

NPI: 1487627089
Provider Name (Legal Business Name): EDWARD S HANNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4900
US

IV. Provider business mailing address

PO BOX 7068
PORTSMOUTH VA
23707-0068
US

V. Phone/Fax

Practice location:
  • Phone: 757-436-7888
  • Fax: 757-548-5669
Mailing address:
  • Phone: 757-686-3508
  • Fax: 757-686-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101035429
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: