Healthcare Provider Details

I. General information

NPI: 1831190446
Provider Name (Legal Business Name): JOHN L HAHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 HOSPITAL DR SUITE 104
PETERSBURG WV
26847-9549
US

IV. Provider business mailing address

PO BOX 1019 C/O GRANT MEMORIAL HOSPITAL
PETERSBURG WV
26847-1019
US

V. Phone/Fax

Practice location:
  • Phone: 304-257-2152
  • Fax: 304-257-2928
Mailing address:
  • Phone: 304-257-1026
  • Fax: 304-257-1932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number13988
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: