Provider Demographics
NPI:1376843094
Name:HASSAN KASSAMALI, MD PA
Entity Type:Organization
Organization Name:HASSAN KASSAMALI, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAMALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:410-687-0000
Mailing Address - Street 1:17 FONTANA LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3017
Mailing Address - Country:US
Mailing Address - Phone:410-687-0000
Mailing Address - Fax:410-391-8656
Practice Address - Street 1:17 FONTANA LN
Practice Address - Street 2:SUITE 101
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3017
Practice Address - Country:US
Practice Address - Phone:410-687-0000
Practice Address - Fax:410-391-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046126207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty