Individual
PETER C. HANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7916 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 432-2297
(260) 434-6433
Mailing address
6920 POINTE INVERNESS WAY STE 200, MEDPARTNERS, ATTN: BARB COPELAND, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01038244A
IN
207RI0011X
Interventional Cardiology Physician
01038244A
IN
207UN0901X
Nuclear Cardiology Physician
01038244A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000087426
ANTHEM
IN
05
—
0781695
—
OH
05
—
100262190
—
IN
01
—
260690NNN
MEDICARE
IN
01
—
P00783720
RAILROAD
IN
Enumeration date
01/19/2006
Last updated
09/23/2020
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