Basic Information
| Provider Information | |||||||||
| NPI: | 1841279866 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANNA | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 213 S JEFFERSON ST STE 625 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240111713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5402245516 | ||||||||
| FaxNumber: | 5402245684 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178220845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702147967 | ||||||||
| FaxNumber: | 5702142800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 05/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 46992 | MN | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0120X | MD60466675 | WA | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | P0598 | TX | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | 86126 | MT | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | 0101269229 | VA | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | 36197 | OK | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 208600000X | E-13904 | AR | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 899618100 | 05 | MN | MEDICAID | 200442230A | 05 | OK | MEDICAID |