Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mariya M Hanneman, PA-C

Individual provider Medical Physician Assistant · NPI 1265764112

Mariya M Hanneman, PA-C is a Physician Assistant in Charlotte, North Carolina. Qualified in 2009, 17 years ago. Practices with Fastmed PC, a 176-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
17
Licensed in
NC
In the registry since
2010
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

501 S Sharon Amity Rd Ste 300
Charlotte, NC 28211-0035
Phone: (704) 377-2424
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 2280 Us Highway 70 Se, Hickory, NC 28602-5164 — (828) 404-3656
  • 9121 Sam Furr Rd Ste 108, Huntersville, NC 28078-8235 — (704) 324-3590

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-02169 (NC)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 0010-02169 (NC)

Record details

NPI number1265764112
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedFebruary 3, 2010
Last updated in NPPESOctober 16, 2025
Certification dateOctober 16, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice Fastmed Pc — 176 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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