Provider Demographics
NPI:1467890053
Name:HASAN, NADIA (DO)
Entity Type:Individual
Prefix:DR
First Name:NADIA
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-7411
Mailing Address - Country:US
Mailing Address - Phone:215-893-6200
Mailing Address - Fax:215-893-6215
Practice Address - Street 1:1840 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146
Practice Address - Country:US
Practice Address - Phone:215-893-6200
Practice Address - Fax:215-893-6215
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015209207Q00000X
PAOS017866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA514196YEBKMedicare PIN
PA514196YUNMMedicare PIN