Provider Demographics
NPI:1245211770
Name:SHAMMA, HASSAN NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:NICHOLAS
Last Name:SHAMMA
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:PO BOX 20452
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0452
Mailing Address - Country:US
Mailing Address - Phone:614-457-8180
Mailing Address - Fax:614-583-3300
Practice Address - Street 1:210A E SPRING VALLEY PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-2653
Practice Address - Country:US
Practice Address - Phone:937-412-4230
Practice Address - Fax:937-435-4230
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.076407207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0117915Medicaid
IL036111190Medicaid
IN201283620Medicaid
KY7100331780Medicaid
AZ166849Medicaid