Healthcare Provider Details

I. General information

NPI: 1396325874
Provider Name (Legal Business Name): HANNAH NOEL THACKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13198 JAMES MADISON HWY
ORANGE VA
22960-2851
US

IV. Provider business mailing address

13198 JAMES MADISON HWY
ORANGE VA
22960-2851
US

V. Phone/Fax

Practice location:
  • Phone: 540-672-3010
  • Fax: 540-672-5713
Mailing address:
  • Phone: 540-672-3010
  • Fax: 540-672-5713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101282217
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: