Provider Demographics
NPI:1386769420
Name:HANKINS, ALTHEA VERNICE (MD)
Entity type:Individual
Prefix:DR
First Name:ALTHEA
Middle Name:VERNICE
Last Name:HANKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-2138
Mailing Address - Country:US
Mailing Address - Phone:215-842-1075
Mailing Address - Fax:215-842-2290
Practice Address - Street 1:5801 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2138
Practice Address - Country:US
Practice Address - Phone:215-842-1075
Practice Address - Fax:215-842-2290
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031719E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000981877Medicaid
PA000981877Medicaid
PAB34129Medicare UPIN