Provider Demographics
NPI:1871755603
Name:HANOVER MEDICAL SPECIALISTS PA
Entity type:Organization
Organization Name:HANOVER MEDICAL SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAISENHELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-815-0889
Mailing Address - Street 1:1515 DOCTORS CIR
Mailing Address - Street 2:HANOVER MEDICAL SPECIALISTS PA
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7403
Mailing Address - Country:US
Mailing Address - Phone:910-763-1219
Mailing Address - Fax:910-343-9702
Practice Address - Street 1:1515 DOCTORS CIR
Practice Address - Street 2:HANOVER MEDICAL SPECIALISTS PA
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7403
Practice Address - Country:US
Practice Address - Phone:910-763-1219
Practice Address - Fax:910-343-9702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANOVER MEDICAL SPECIALITS - ENDOSCOPY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40135261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34C0001151OtherASC IDENTIFICATION NUMBER