Basic Information
| Provider Information | |||||||||
| NPI: | 1457349243 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAHN | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 BROOKS POINT LN | ||||||||
| Address2: | |||||||||
| City: | UNION HALL | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241763881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405761971 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1906 BELLEVIEW AVE SE | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240141838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409817000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 0024065720 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 9554840 | 05 | VA | MEDICAID | 010267366 | 05 | VA | MEDICAID | 010267935 | 05 | VA | MEDICAID | 010267404 | 05 | VA | MEDICAID | 010267901 | 05 | VA | MEDICAID | 010267382 | 05 | VA | MEDICAID |