Provider Demographics
NPI:1205231792
Name:ALLAN, HASSAN FAYEK (PA-C)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:FAYEK
Last Name:ALLAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 EXECUTIVE PL 3RD & 4TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5193
Mailing Address - Country:US
Mailing Address - Phone:910-615-3700
Mailing Address - Fax:
Practice Address - Street 1:711 EXECUTIVE PL 3RD & 4TH FLOOR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5193
Practice Address - Country:US
Practice Address - Phone:910-615-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001005028363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant