Provider Demographics
NPI:1306806369
Name:HANSHAW, RICHARD E (PA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:HANSHAW
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:416 COLEGATE DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9549
Mailing Address - Country:US
Mailing Address - Phone:740-568-4814
Mailing Address - Fax:740-374-3165
Practice Address - Street 1:807 FARSON ST STE 126
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1068
Practice Address - Country:US
Practice Address - Phone:740-374-7985
Practice Address - Fax:740-374-7990
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2021-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH50.004708RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0185170Medicaid
OHH524170Medicare PIN
OH0185170Medicaid