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1144433681

NPI Code Detail

MEDICARE: DR. TARESSA GILLIG HANEY M.D.

MEDICARE: DR. TARESSA GILLIG HANEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	2008-00936	NC
2	207W00000X	Ophthalmology Physician	01059626A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
12	P01223901	OTHER	NC	MEDICARE-RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2687	OTHER	NC	EVOLUTIONS HEALTHCARE
2	01212093	OTHER	SC	AMERIGROUP COMMUNITY CARE
3	56162	OTHER	NC	MEDCOST
4	9457063	OTHER	NC	AETNA
5	150TA	OTHER	NC	BCBSNC
6	000000289876	OTHER	SC	UNISON HEALTH PLAN OF SC
7	20090727	OTHER	SC	SELECT HEALTH OF SC
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	770893	OTHER	SC	WELLCARE
11	87882	OTHER	SC	CHCCARES OF SC

General Provider Information

NPI Number	:	1144433681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARESSA GILLIG HANEY M.D.

Provider Business Mailing Address
First Line	:	6035 FAIRVIEW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3256
Country	:	US
Telephone Number	:	704-295-3000
Fax Number	:	704-838-8494

Provider Business Practice Location Address
First Line	:	400 PARK ST
Second Line	:
City	:	BELMONT
State	:	NC
Zip	:	28012-3368
Country	:	US
Telephone Number	:	704-295-3700
Fax Number	:	704-838-8494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	03/30/2021

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Directions to “ DR. TARESSA GILLIG HANEY M.D.” Practice Location

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