Provider Demographics
NPI:1396365813
Name:HASSAN, AHMED A (MD)
Entity Type:Individual
Prefix:
First Name:AHMED
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:EL-SALAM TOWER , NAFE ST
Mailing Address - Street 2:APARTMENT 22
Mailing Address - City:DAMIETTA
Mailing Address - State:DAMIETTA
Mailing Address - Zip Code:34511
Mailing Address - Country:EG
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MCGREGOR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3770
Practice Address - Country:US
Practice Address - Phone:603-663-5310
Practice Address - Fax:603-663-8015
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2023-05-17
Deactivation Date:2022-01-10
Deactivation Code:
Reactivation Date:2022-05-02
Provider Licenses
StateLicense IDTaxonomies
390200000X
NH23547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program