Healthcare Provider Details

I. General information

NPI: 1831181304
Provider Name (Legal Business Name): JERRY MITCHELL HAHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 50 EAST SUNRISE PROFESSIONAL BUILDING
ROMNEY WV
26757
US

IV. Provider business mailing address

2076 STACKS GAP RD
WARDENSVILLE WV
26851
US

V. Phone/Fax

Practice location:
  • Phone: 304-822-3838
  • Fax:
Mailing address:
  • Phone: 304-822-3838
  • Fax: 304-822-7665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number15226
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15226
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: