Provider Demographics
NPI:1710982053
Name:HASAN, SAMER S (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SAMER
Middle Name:S
Last Name:HASAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 THOMAS MORE PKWY
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3488
Mailing Address - Country:US
Mailing Address - Phone:513-347-9999
Mailing Address - Fax:859-344-4153
Practice Address - Street 1:328 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3488
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:859-344-4153
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH78581207XX0005X
KY36117207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64040124Medicaid
OH2205303Medicaid
OHHA4031583Medicare PIN
OH2205303Medicaid
KY64040124Medicaid