MEDICARE: DR. DERICK ANTHONY HANLAN 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	2085R0001X	Radiation Oncology Physician	0101031979	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598766818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERICK ANTHONY HANLAN M.D

Provider Business Mailing Address
First Line	:	891 LINGANORE DR
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-2143
Country	:	US
Telephone Number	:	703-558-6284
Fax Number	:	703-558-5512

Provider Business Practice Location Address
First Line	:	1701 N GEORGE MASON DR
Second Line	:	RADIATION ONCOLOGY DEPT
City	:	ARLINGTON
State	:	VA
Zip	:	22205-3610
Country	:	US
Telephone Number	:	703-558-6284
Fax Number	:	703-558-5512

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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