Provider Demographics
NPI:1144714155
Name:FANELLI, HANNAH (MD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:FANELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:132 ABIGAIL LN
Practice Address - Street 2:
Practice Address - City:PORT MATILDA
Practice Address - State:PA
Practice Address - Zip Code:16870-7153
Practice Address - Country:US
Practice Address - Phone:814-272-7100
Practice Address - Fax:814-272-6501
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT215789390200000X
PAMD473904207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program