Provider Demographics
NPI:1992920169
Name:HANNAH, PAUL L (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:L
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 1:3787 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46408-2142
Mailing Address - Country:US
Mailing Address - Phone:219-981-4800
Mailing Address - Fax:219-981-4805
Practice Address - Street 1:3787 GRANT ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46408-2142
Practice Address - Country:US
Practice Address - Phone:219-981-4800
Practice Address - Fax:219-981-4805
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010315852084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100213680 AMedicaid
IN200473640AMedicaid