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General NPI Number Information
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NPI Number | 1902868086
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Entity Type | Individual
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Provider Name | CARMEN KATHY HANSFORD M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 125 E BROAD ST STE 302
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City | ELYRIA
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State | OH
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Zip | 44035-6400
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Country | US
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Telephone | 440-323-0258
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Fax | 216-201-6250
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Provider Business Mailing Address
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Address Line | 24701 EUCLID AVE THIRD FLOOR BILLING SERVICES
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City | EUCLID
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State | OH
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Zip | 44117-1714
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Country | US
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Telephone | 440-323-0258
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Fax | 216-201-6250
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35051857
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License Number State | OH
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