Provider Demographics
NPI:1730260670
Name:HANLON, KIM ANNE (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:ANNE
Last Name:HANLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-3445
Mailing Address - Country:US
Mailing Address - Phone:724-722-5238
Mailing Address - Fax:724-722-5288
Practice Address - Street 1:WESTINGHOUSE, INTERSTATE 70,EXIT54
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:PA
Practice Address - Zip Code:15663
Practice Address - Country:US
Practice Address - Phone:724-722-5238
Practice Address - Fax:724-722-5288
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027582E2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAA84528Medicare UPIN