Provider Demographics
NPI:1730164732
Name:HANSEN, NOBLE M JR (MD)
Entity type:Individual
Prefix:DR
First Name:NOBLE
Middle Name:M
Last Name:HANSEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-0789
Mailing Address - Country:US
Mailing Address - Phone:413-509-1000
Mailing Address - Fax:413-509-1003
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:SUITE 305 TITUS CLARKE & HANSEN ORTHOPEDIC SURGEONS PC
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2301
Practice Address - Country:US
Practice Address - Phone:413-788-7321
Practice Address - Fax:413-733-6369
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA51803207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3003779Medicaid
200010515Medicare PIN
MAJ02715Medicare PIN
MADX1080Medicare PIN
MA3003779Medicaid