Healthcare Provider Details

I. General information

NPI: 1487618583
Provider Name (Legal Business Name): GEORGE KRISTIAN HANSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 SIGNATURE WAY
HAMPTON VA
23666-5966
US

IV. Provider business mailing address

26 FERGUSON ST
POQUOSON VA
23662-1221
US

V. Phone/Fax

Practice location:
  • Phone: 757-723-3549
  • Fax: 757-723-2999
Mailing address:
  • Phone: 757-868-6566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101031901
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: