Provider Demographics
NPI:1467533364
Name:HASAN, RAZI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAZI
Middle Name:
Last Name:HASAN
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 1:1 RANDALL SQ
Mailing Address - Street 2:SUITE 404
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904
Mailing Address - Country:US
Mailing Address - Phone:401-861-5183
Mailing Address - Fax:401-861-5276
Practice Address - Street 1:1 RANDALL SQ
Practice Address - Street 2:SUITE 404
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904
Practice Address - Country:US
Practice Address - Phone:401-861-5183
Practice Address - Fax:401-861-5276
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10462208000000X, 2080P0006X, 2080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7006110Medicaid
RI7006110Medicaid