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NPI Code Detail

MEDICARE: B A HANNA MD PROF CORP

MEDICARE: B A HANNA MD PROF CORP
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
1208600000XSurgery Physician9626NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CC6526OTHERNVANTHEM BX BS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730387010
Entity Type Code : Organization
Provider Name (Legal Business Name) : B A HANNA MD PROF CORP
Provider Business Mailing Address
First Line : 6930 S CIMARRON RD STE 220
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-2404
Country : US
Telephone Number : 702-384-1160
Fax Number : 702-835-0676
Provider Business Practice Location Address
First Line : 6930 S CIMARRON RD STE 220
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-2404
Country : US
Telephone Number : 702-384-1160
Fax Number : 702-835-0676
Authorized Official
Title or Position : PRESIDENT
Name : DR. BERNADINE A HANNA
Credential : MD
Telephone Number : 702-384-1160
Provider Enumeration Date : 07/06/2007
Last Update Date : 03/04/2026

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