Provider Demographics
NPI:1154370567
Name:HANES, DAVID PAUL (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:HANES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-0435
Mailing Address - Country:US
Mailing Address - Phone:215-969-7510
Mailing Address - Fax:215-969-7513
Practice Address - Street 1:9501 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1025
Practice Address - Country:US
Practice Address - Phone:215-969-7510
Practice Address - Fax:215-969-7513
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1582028OtherBLUE SHIELD
PA075878VRKMedicare PIN
PA1582028OtherBLUE SHIELD