Provider Demographics
NPI:1487618583
Name:HANSON, GEORGE KRISTIAN (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:KRISTIAN
Last Name:HANSON
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 1:26 FERGUSON ST
Mailing Address - Street 2:
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-1221
Mailing Address - Country:US
Mailing Address - Phone:757-868-6566
Mailing Address - Fax:
Practice Address - Street 1:113 SIGNATURE WAY
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5966
Practice Address - Country:US
Practice Address - Phone:757-723-3549
Practice Address - Fax:757-723-2999
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031901207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010040612Medicaid
VA050020823Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VA010040612Medicaid
VAB08342Medicare UPIN
VA050000429Medicare ID - Type Unspecified