Provider Demographics
NPI:1225302615
Name:MARIO HASAJ, LLC
Entity Type:Organization
Organization Name:MARIO HASAJ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:HASAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-221-0235
Mailing Address - Street 1:2643 GRAFTON ROAD
Mailing Address - Street 2:MARIO HASAJ, LLC
Mailing Address - City:TOWNSHEND
Mailing Address - State:VT
Mailing Address - Zip Code:05353
Mailing Address - Country:US
Mailing Address - Phone:802-221-0235
Mailing Address - Fax:
Practice Address - Street 1:2643 GRAFTON ROAD
Practice Address - Street 2:MARIO HASAJ, LLC
Practice Address - City:TOWNSHEND
Practice Address - State:VT
Practice Address - Zip Code:05353
Practice Address - Country:US
Practice Address - Phone:802-221-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00111432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTG98525Medicare UPIN