Healthcare Provider Details

I. General information

NPI: 1619969227
Provider Name (Legal Business Name): ROBERT BLAINE HANSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6275 E VIRGINIA BEACH BLVD SUITE 303
NORFOLK VA
23502-2851
US

IV. Provider business mailing address

6275 E VIRGINIA BEACH BLVD SUITE 303
NORFOLK VA
23502-2851
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-3141
  • Fax: 757-461-1658
Mailing address:
  • Phone: 757-461-3141
  • Fax: 757-461-1658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number0101041467
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: