Provider Demographics
NPI:1588664692
Name:HANNES, ANDREW PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PAUL
Last Name:HANNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:91 LAKES RD
Mailing Address - Street 2:MED ARTS BLDG
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-2613
Mailing Address - Country:US
Mailing Address - Phone:845-782-8608
Mailing Address - Fax:845-782-8516
Practice Address - Street 1:91 LAKES RD
Practice Address - Street 2:MED ARTS BLDG
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-2613
Practice Address - Country:US
Practice Address - Phone:845-782-8608
Practice Address - Fax:845-782-8516
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY104143208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B16636Medicare UPIN
NY018234Medicare ID - Type Unspecified