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NPI Code Detail

MEDICARE: MARK G HANLY MBCHB, FRCPATHLOND

MEDICARE: MARK G HANLY MBCHB, FRCPATHLOND
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician035181GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619951258
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK G HANLY MBCHB, FRCPATHLOND
Provider Business Mailing Address
First Line : PO BOX 30309
Second Line :
City : CHARLESTON
State : SC
Zip : 29417-0309
Country : US
Telephone Number : 843-554-9300
Fax Number : 843-566-8780
Provider Business Practice Location Address
First Line : 203 INDIGO DR
Second Line :
City : BRUNSWICK
State : GA
Zip : 31525-6865
Country : US
Telephone Number : 912-261-2669
Fax Number : 912-261-0561
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2005
Last Update Date : 08/30/2011

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