Provider Demographics
NPI:1285896829
Name:HANSON, MATTHEW RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RUSSELL
Last Name:HANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:537 STANTON CHRISTIANA RD
Mailing Address - Street 2:STE 207
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2148
Mailing Address - Country:US
Mailing Address - Phone:215-762-5550
Mailing Address - Fax:215-762-5570
Practice Address - Street 1:537 STANTON CHRISTIANA ROAD, SIUTE 107
Practice Address - Street 2:APEX MEDICAL CENTER
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-0000
Practice Address - Country:US
Practice Address - Phone:302-633-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT185849207N00000X
DEC1-0009352207N00000X, 207ND0900X
PAMD436874207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology