=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215013651
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REEM SALAH HANNA M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 03/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 FREEPORT RD SUITE 6 FELDARELLI SQUARE
-----------------------------------------------------
City | NEW KENSINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15068-4669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-335-6611
-----------------------------------------------------
Fax | 724-335-3711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 FREEPORT RD SUITE 6 FELDARELLI SQUARE
-----------------------------------------------------
City | NEW KENSINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15068-4669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-335-6611
-----------------------------------------------------
Fax | 724-335-3711
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MD065493L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------