Provider Demographics
NPI:1346370905
Name:FARZANEH HASSANI, MD, PLLC
Entity Type:Organization
Organization Name:FARZANEH HASSANI, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FARZANEH
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-291-5275
Mailing Address - Street 1:1195 PINEVIEW DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3461
Mailing Address - Country:US
Mailing Address - Phone:304-291-5275
Mailing Address - Fax:304-296-4381
Practice Address - Street 1:3160 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5202
Practice Address - Country:US
Practice Address - Phone:916-731-1952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20075207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001708631OtherBS PAY TO NUMBER
WVFA9327771Medicare ID - Type UnspecifiedMEDICARE GROUP