Provider Demographics
NPI:1518067859
Name:ELKASSAS, HAZEM F (MD)
Entity Type:Individual
Prefix:DR
First Name:HAZEM
Middle Name:F
Last Name:ELKASSAS
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:PO BOX 447
Mailing Address - Street 2:100 HOSPITAL AVE
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0447
Mailing Address - Country:US
Mailing Address - Phone:814-375-3535
Mailing Address - Fax:814-375-3563
Practice Address - Street 1:100 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1440
Practice Address - Country:US
Practice Address - Phone:814-375-3535
Practice Address - Fax:814-375-3563
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049607L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014691360006Medicaid
PA830007548OtherRAILROAD MEDICARE
PA0014691360006Medicaid
PA143059Medicare PIN