Provider Demographics
NPI:1346226453
Name:HASSAN, HOSSAN A (MD)
Entity Type:Individual
Prefix:MR
First Name:HOSSAN
Middle Name:A
Last Name:HASSAN
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:P.O. BOX 918
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512
Mailing Address - Country:US
Mailing Address - Phone:843-454-0841
Mailing Address - Fax:815-654-8020
Practice Address - Street 1:1035 CHERAW ST.
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512
Practice Address - Country:US
Practice Address - Phone:843-454-0442
Practice Address - Fax:843-777-6871
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23135207Q00000X
SCMD23135174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC405127Medicaid
SC7472114OtherCIGNA
SC000000270686OtherUNISON
SC062OtherBCBS
SC218077OtherMEDCOST
SC063OtherBCBS
SC231350Medicaid
SC18500OtherEVOLUTIONS
SC231350Medicaid
SC5078Medicare PIN