Provider Demographics
NPI:1740419175
Name:HASAN, WAQAR MAHMUD (MD)
Entity Type:Individual
Prefix:
First Name:WAQAR
Middle Name:MAHMUD
Last Name:HASAN
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 1:1111 W 10TH ST
Mailing Address - Street 2:PB A212
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-4800
Mailing Address - Country:US
Mailing Address - Phone:317-274-1224
Mailing Address - Fax:317-274-1248
Practice Address - Street 1:703 PRO-MED LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5317
Practice Address - Country:US
Practice Address - Phone:317-843-9922
Practice Address - Fax:317-581-9922
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000348A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)