Provider Demographics
NPI:1730192949
Name:HANNAH, RICHARD J (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
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 1:81 HIGHLAND AVE
Mailing Address - Street 2:NORTH SHORE HEALTH SYSTEMS
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-354-4173
Mailing Address - Fax:
Practice Address - Street 1:79 HIGHLAND AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-744-0650
Practice Address - Fax:978-744-0655
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1730192949OtherBLUE CROSS BLUE SHIELD
MA1730192949Medicaid
MA1730192949Medicaid
MA1730192949OtherBLUE CROSS BLUE SHIELD