MEDICARE: MR. CHARLES D HANSON 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	014584	ME
2	2084P0800X	Psychiatry Physician	11849	NH
3	2084P0800X	Psychiatry Physician	74077	MA

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	:	1679573257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES D HANSON MD

Provider Business Mailing Address
First Line	:	52 PARK ST
Second Line	:
City	:	ORONO
State	:	ME
Zip	:	04473-4406
Country	:	US
Telephone Number	:	207-866-0408
Fax Number	:	207-989-5743

Provider Business Practice Location Address
First Line	:	52 PARK ST
Second Line	:
City	:	ORONO
State	:	ME
Zip	:	04473-4406
Country	:	US
Telephone Number	:	207-866-0408
Fax Number	:	207-989-5743

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	03/17/2008

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