Provider Demographics
NPI:1164614160
Name:SHAKOOR, HASAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HASAN
Middle Name:
Last Name:SHAKOOR
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 1:501 FAIRMOUNT AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5457
Mailing Address - Country:US
Mailing Address - Phone:410-494-7920
Mailing Address - Fax:410-902-8247
Practice Address - Street 1:515 FAIRMOUNT AVE STE 500
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-494-1662
Practice Address - Fax:410-494-1718
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57009723207R00000X, 207RC0200X, 207RP1001X
MDD74214207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD242462ZB6FOtherMEDICARE PTAN
MD418515300Medicaid