Provider Demographics
NPI:1134464126
Name:HASAN, FAISAL (FAISAL HASAN)
Entity Type:Individual
Prefix:
First Name:FAISAL
Middle Name:
Last Name:HASAN
Suffix:
Gender:M
Credentials:FAISAL HASAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46770 WILLOWOOD PL
Mailing Address - Street 2:
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-7588
Mailing Address - Country:US
Mailing Address - Phone:703-404-4706
Mailing Address - Fax:
Practice Address - Street 1:46770 WILLOWOOD PLACE
Practice Address - Street 2:
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165
Practice Address - Country:US
Practice Address - Phone:703-404-4706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSA0012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist