MEDICARE: DONAL T O'HANLON MD

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	2084P0800X	Psychiatry Physician	042004	CT
2	2084P0800X	Psychiatry Physician	158935	MA

General Provider Information

NPI Number	:	1548267107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONAL T O'HANLON MD

Provider Business Mailing Address
First Line	:	280 CHESTNUT STREET
Second Line	:	2ND FLOOR
City	:	SPRINGFIELD
State	:	MA
Zip	:	01199
Country	:	US
Telephone Number	:	413-794-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	759 CHESTNUT STREET
Second Line	:	S5632
City	:	SPRINGFIELD
State	:	MA
Zip	:	01199
Country	:	US
Telephone Number	:	413-794-4326
Fax Number	:

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	06/18/2009

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