Healthcare Provider Details

I. General information

NPI: 1902846645
Provider Name (Legal Business Name): ZACHARY HENRY LEE HANSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/01/2022
Certification Date: 01/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 20TH ST
HUNTINGTON WV
25703-1850
US

IV. Provider business mailing address

1600 MEDICAL CENTER DR
HUNTINGTON WV
25701-3656
US

V. Phone/Fax

Practice location:
  • Phone: 304-696-8700
  • Fax: 304-696-8701
Mailing address:
  • Phone: 304-691-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22055
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: