Provider Demographics
NPI:1598847683
Name:HASAN, MANSOOR -- (MD)
Entity Type:Individual
Prefix:DR
First Name:MANSOOR
Middle Name:--
Last Name:HASAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2002 LINCOLNSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157
Mailing Address - Country:US
Mailing Address - Phone:601-954-3312
Mailing Address - Fax:601-364-1394
Practice Address - Street 1:GV SONNY MONTGOMERY VAMC PHY&REHAB (117)
Practice Address - Street 2:1500 E WOODROW WILSON DRIVE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39157
Practice Address - Country:US
Practice Address - Phone:601-964-3312
Practice Address - Fax:601-364-1394
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2357192081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine