Provider Demographics
NPI:1730273772
Name:HANNA, EKRAM L (MD)
Entity type:Individual
Prefix:
First Name:EKRAM
Middle Name:L
Last Name:HANNA
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 1:201 LAUREL HEIGHTS DRIVE
Mailing Address - Street 2:INTERNAL MEDICINE ASSOCIATES
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3635
Mailing Address - Country:US
Mailing Address - Phone:856-455-4800
Mailing Address - Fax:856-451-0650
Practice Address - Street 1:201 LAUREL HEIGHTS DRIVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-3635
Practice Address - Country:US
Practice Address - Phone:856-455-4800
Practice Address - Fax:856-451-0650
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ862460701Medicaid
NJ862460701Medicaid
NJH38477Medicare UPIN