Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 36196 | NC |
NPI | 1114919792 |
---|---|
Provider Name | Dr. David W Hannon |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-8982 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 03/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
39066 | BCBS NC (01) | NC |
60056285 | RAILROAD MEDICARE (01) | NC |
8939066 | (05) | NC |
C02836 | (02) | NC |