Provider Demographics
NPI:1578785531
Name:HASSAN, AWAD ABDULFATAH
Entity Type:Individual
Prefix:MR
First Name:AWAD
Middle Name:ABDULFATAH
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 1:551 SADDLETREE DR.
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1148
Mailing Address - Country:US
Mailing Address - Phone:614-778-4700
Mailing Address - Fax:614-759-9392
Practice Address - Street 1:551 SADDLETREE DR.
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1148
Practice Address - Country:US
Practice Address - Phone:614-778-4700
Practice Address - Fax:614-759-9392
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2355615Medicaid