Provider Demographics
NPI:1508331992
Name:HANSEN, DANIEL R (PA-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:HANSEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:215-402-8002
Mailing Address - Fax:412-362-9063
Practice Address - Street 1:5609 5TH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-2601
Practice Address - Country:US
Practice Address - Phone:412-362-3500
Practice Address - Fax:412-362-9063
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060253363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103599230-0001Medicaid