Provider Demographics
NPI:1376679761
Name:HASSAN, BRETT (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
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 1:215 WEST ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2277
Mailing Address - Country:US
Mailing Address - Phone:508-478-6366
Mailing Address - Fax:508-473-2636
Practice Address - Street 1:215 WEST ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2277
Practice Address - Country:US
Practice Address - Phone:508-478-6366
Practice Address - Fax:508-473-2636
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229062207R00000X
MA238133207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA002740101Medicare PIN