Provider Demographics
NPI:1558416040
Name:HAHN, SUHDONG (MD)
Entity Type:Individual
Prefix:DR
First Name:SUHDONG
Middle Name:
Last Name:HAHN
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 1:333 SCHOOL ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5334
Mailing Address - Country:US
Mailing Address - Phone:401-722-0305
Mailing Address - Fax:401-726-4720
Practice Address - Street 1:333 SCHOOL ST
Practice Address - Street 2:SUITE 107
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5334
Practice Address - Country:US
Practice Address - Phone:401-722-0305
Practice Address - Fax:401-726-4720
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD4681207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000735Medicaid
RI7000693Medicaid
RI9000735Medicaid
RI069000735Medicare PIN