Provider Demographics
NPI:1548298474
Name:HANNAH, BRIAN A (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:HANNAH
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:P. O. BOX 8500 - 6395
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:FRANKFORD HOSPITAL HEALTH CENTER CLINIC
Practice Address - Street 2:5000 FRANKFORD AVE - 1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124
Practice Address - Country:US
Practice Address - Phone:215-831-2355
Practice Address - Fax:215-831-2017
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038505E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011937610002Medicaid
PA0189637000OtherKEYSTONE, IBC
PA3566450OtherCIGNA
PA0011937610012Medicaid
PAPA0046718OtherTRICARE
PA0011937610001Medicaid
PA02139OtherHEATH PARTNERS
PA1590009OtherFIRST HEALTH
PA513266OtherHIGHMARK, BLUE SHIELD
PA0011937610014Medicaid
PA01109452OtherKEYSTONE MERCY
PA01193761-02OtherAMERICHOICE
PA110090940OtherRAILROAD MEDICARE
PA1829936OtherPHCS
PA513266OtherPERSONAL CHOICE
PA513266OtherHIGHMARK, BLUE SHIELD