Provider Demographics
NPI:1225068968
Name:YOUSUF, HASAN MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:HASAN
Middle Name:MOHAMMED
Last Name:YOUSUF
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 1:8266 ATLEE RD
Mailing Address - Street 2:MOB #2 SUITE 319
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-1804
Mailing Address - Country:US
Mailing Address - Phone:804-764-7965
Mailing Address - Fax:804-765-7969
Practice Address - Street 1:8266 ATLEE ROAD
Practice Address - Street 2:MOB #2 SUITE 319
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116
Practice Address - Country:US
Practice Address - Phone:804-764-7965
Practice Address - Fax:804-764-7969
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237749207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA351622OtherBCBS-CRATER RD
VA1225068968Medicaid
VAP00252942Medicare PIN
VA007978P80Medicare PIN
VA351622OtherBCBS-CRATER RD