Provider Demographics
NPI:1437342714
Name:SULAIMAN B HASAN MD PLLC
Entity Type:Organization
Organization Name:SULAIMAN B HASAN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SULAIMAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-720-5126
Mailing Address - Street 1:2345 CHESTERFIELD AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1069
Mailing Address - Country:US
Mailing Address - Phone:304-720-5126
Mailing Address - Fax:304-720-5128
Practice Address - Street 1:2345 CHESTERFIELD AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1069
Practice Address - Country:US
Practice Address - Phone:304-720-5126
Practice Address - Fax:304-720-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV187952086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010369Medicaid
WVP00422718OtherRAILROAD MEDICARE
WV3810010369Medicaid