Provider Demographics
NPI:1750678645
Name:HASANOVIC, MIRSADA (DPM)
Entity Type:Individual
Prefix:DR
First Name:MIRSADA
Middle Name:
Last Name:HASANOVIC
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:MIRSADA
Other - Middle Name:
Other - Last Name:DUDIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2202 EXECUTIVE DR STE A
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6604
Mailing Address - Country:US
Mailing Address - Phone:757-827-7111
Mailing Address - Fax:757-827-7164
Practice Address - Street 1:2202 EXECUTIVE DR STE A
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6604
Practice Address - Country:US
Practice Address - Phone:757-827-7111
Practice Address - Fax:757-827-7164
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301122213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery