Provider Demographics
NPI:1508153032
Name:HOOPER, HASAN ABDUL (CST, CSA)
Entity Type:Individual
Prefix:MR
First Name:HASAN
Middle Name:ABDUL
Last Name:HOOPER
Suffix:
Gender:M
Credentials:CST, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 1/2 SUSSEX RD
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-3817
Mailing Address - Country:US
Mailing Address - Phone:646-489-0692
Mailing Address - Fax:
Practice Address - Street 1:3622 1/2 SUSSEX RD
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-3817
Practice Address - Country:US
Practice Address - Phone:646-489-0692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3431246ZC0007X
CO113968246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist