Healthcare Provider Details

I. General information

NPI: 1700848363
Provider Name (Legal Business Name): CARL ROBERT HANNAH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/25/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HICKOK ST
CHRISTIANSBURG VA
24073-3524
US

IV. Provider business mailing address

6 HICKOK ST
CHRISTIANSBURG VA
24073-3524
US

V. Phone/Fax

Practice location:
  • Phone: 540-383-6148
  • Fax: 540-382-4191
Mailing address:
  • Phone: 540-383-6148
  • Fax: 540-382-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101235860
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: