Provider Demographics
NPI:1003802463
Name:YASSA, HANY NAGY (MD)
Entity Type:Individual
Prefix:DR
First Name:HANY
Middle Name:NAGY
Last Name:YASSA
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:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-1029
Mailing Address - Country:US
Mailing Address - Phone:505-637-7430
Mailing Address - Fax:505-637-7474
Practice Address - Street 1:405 W COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5209
Practice Address - Country:US
Practice Address - Phone:505-622-8170
Practice Address - Fax:505-624-8726
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53263207R00000X, 208M00000X
NM2002-0386207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM007E65OtherBCBS
NM97306754Medicaid
NMH76903Medicare UPIN
NM344529801Medicare PIN