Provider Demographics
NPI:1497141089
Name:HASSAN, HASSAN
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:HASSAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4322 EXECUTIVE PKWY
Mailing Address - Street 2:APT 418
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3880
Mailing Address - Country:US
Mailing Address - Phone:614-776-4015
Mailing Address - Fax:614-776-4015
Practice Address - Street 1:4322 EXECUTIVE PKWY
Practice Address - Street 2:APT 418
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3880
Practice Address - Country:US
Practice Address - Phone:614-776-4015
Practice Address - Fax:614-776-4015
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHGHF343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)