Provider Demographics
NPI:1871597815
Name:HENNAN-HAIN, PEARL ELEANOR (DO)
Entity type:Individual
Prefix:MRS
First Name:PEARL
Middle Name:ELEANOR
Last Name:HENNAN-HAIN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1471
Mailing Address - Country:US
Mailing Address - Phone:740-302-1777
Mailing Address - Fax:
Practice Address - Street 1:115 N 3RD ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1471
Practice Address - Country:US
Practice Address - Phone:740-377-2712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02639208000000X
OH34.014539208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64011059Medicaid
KY000000550502OtherANTHEM BCBS
OH2771429Medicaid
KY000000076728OtherANTHEM BC/BS
G05276Medicare UPIN