Provider Demographics
NPI:1750589164
Name:HANLEY, GERALD THOMAS (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:THOMAS
Last Name:HANLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17417 SHED CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-7230
Mailing Address - Country:US
Mailing Address - Phone:618-982-2607
Mailing Address - Fax:
Practice Address - Street 1:17417 SHED CHURCH RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-7230
Practice Address - Country:US
Practice Address - Phone:618-982-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-417652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology