Provider Demographics
NPI:1477548865
Name:HASAN, AHMED M (MD)
Entity Type:Individual
Prefix:MR
First Name:AHMED
Middle Name:M
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 1:204 STATE RD
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-2827
Mailing Address - Country:US
Mailing Address - Phone:610-379-0443
Mailing Address - Fax:610-379-4725
Practice Address - Street 1:204 STATE RD
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-2827
Practice Address - Country:US
Practice Address - Phone:610-379-0443
Practice Address - Fax:610-379-4725
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055983L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015523300002Medicaid
PA078998Medicare ID - Type Unspecified
PA0015523300002Medicaid