Basic Information
| Provider Information | |||||||||
| NPI: | 1649353368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANES | ||||||||
| FirstName: | VERNA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MAPLEWOOD AVENUE | ||||||||
| Address2: | |||||||||
| City: | RONCEVERTE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249701398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046471148 | ||||||||
| FaxNumber: | 3046473006 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 MAPLEWOOD AVENUE | ||||||||
| Address2: | |||||||||
| City: | RONCEVERTE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249701398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046471148 | ||||||||
| FaxNumber: | 3046473006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 03/12/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G7226 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0101027752 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | C10007490 | DE | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 15676 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1000039002 | 05 | DE | MEDICAID |