Provider Demographics
NPI:1508893090
Name:HANNIGAN, NEIL R (MD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:R
Last Name:HANNIGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:MADIGAN ARMY MEDICAL CENTER, NEPHROLOGY SERVICES
Mailing Address - Street 2:9040 JACKSON AVE
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431
Mailing Address - Country:US
Mailing Address - Phone:253-968-1485
Mailing Address - Fax:253-968-1188
Practice Address - Street 1:9040 JACKSON AVENUE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-2028
Practice Address - Country:US
Practice Address - Phone:253-968-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041237207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1116557Medicaid
WA0242914Medicaid
WA1116557Medicaid
WAG8878436Medicare PIN