Provider Demographics
NPI:1992750665
Name:HANNA, SALEM (MD)
Entity type:Individual
Prefix:
First Name:SALEM
Middle Name:
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7835
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:211 FOUNTAIN CT STE 340
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2957
Practice Address - Country:US
Practice Address - Phone:859-263-1280
Practice Address - Fax:859-263-1290
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64306962Medicaid
KY0201658Medicare PIN
KY0919918Medicare PIN
KY64306962Medicaid
KY0290506Medicare PIN
KY0290711Medicare PIN
F93290Medicare UPIN