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Individual

CLARENCE W HANSON III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3400 SPRUCE STREET, 4 DULLES, PHILADELPHIA, PA 19104-4206
(215) 349-8310
Mailing address
3400 SPRUCE STREET, 4 DULLES, PHILADELPHIA, PA 19104-4206
(215) 349-8310

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
MD043548E
PA
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
MD043548E
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001901150002
PA
Enumeration date
06/27/2006
Last updated
02/16/2012
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