Provider Demographics
NPI:1366418097
Name:HANNA, THOMAS A (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:HANNA
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 1:2 JAN SEBASTIAN DR STE 202
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2377
Mailing Address - Country:US
Mailing Address - Phone:774-205-2400
Mailing Address - Fax:774-338-5378
Practice Address - Street 1:2 JAN SEBASTIAN DR STE 202
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2377
Practice Address - Country:US
Practice Address - Phone:774-205-2400
Practice Address - Fax:774-338-5378
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55576207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA66612OtherHPHC
MAJ05559OtherBCBS
J05559Medicare ID - Type Unspecified
B74757Medicare UPIN