Provider Demographics
NPI:1235259672
Name:HASAN, ANSUDDIN S (MD)
Entity Type:Individual
Prefix:
First Name:ANSUDDIN
Middle Name:S
Last Name:HASAN
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 1:785 5TH AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4218
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-217-4300
Practice Address - Fax:717-217-4217
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432763207Q00000X, 208M00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1566553OtherFIRST HEALTH
PA227165OtherUNISON
PA2178745OtherMAMSI
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA50087505OtherCAPITAL BLUECROSS (WH)
PA675442OtherHEALTH AMERICA
PAHA1988417OtherHIGHMARK BLUE SHIELD
PA1711126OtherAETNA HMO
PA25-1716306OtherGREATWEST
PA867633OtherMEDICARE GROUP #
PA9925091OtherAETNA NON-HMO
PAMD432763OtherLICENSE
PA25-1716306OtherINTERGROUP
PA25-1716306OtherHEALTHNET/TRICARE
PA102018553 0002Medicaid
PA1567150OtherGATEWAY
PA25-1716306OtherINFORMED
PA50073016OtherCAPITAL BLUECROSS (HOFC)
PAG920-0084/25RXCUOtherCAREFIRST
PAP00468807OtherRAILROAD MEDICARE
PA120420410OtherDEPT OF LABOR
PA25-1716306OtherDEVON
PA25-1716306OtherMULTIPLAN/PHCS
PA25-1716306OtherMULTIPLAN/PHCS
PAMD432763OtherLICENSE