Provider Demographics
NPI:1265480289
Name:HASAN, NASIR (MD)
Entity Type:Individual
Prefix:DR
First Name:NASIR
Middle Name:
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 1:805 CENTURY MEDICAL DRIVE
Mailing Address - Street 2:CREDENTIALING OFFICE
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3747
Mailing Address - Country:US
Mailing Address - Phone:321-268-6264
Mailing Address - Fax:321-724-8749
Practice Address - Street 1:951 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3747
Practice Address - Country:US
Practice Address - Phone:321-268-6111
Practice Address - Fax:321-268-6360
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75157207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275900400Medicaid
FL37675WMedicare PIN
FL37675ZMedicare PIN