Provider Demographics
NPI:1790895035
Name:HASAN, SYED S (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:S
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 1:2120 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-3859
Mailing Address - Country:US
Mailing Address - Phone:352-666-1703
Mailing Address - Fax:352-666-1366
Practice Address - Street 1:2120 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-3859
Practice Address - Country:US
Practice Address - Phone:352-666-1703
Practice Address - Fax:352-666-1366
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75485207R00000X
NEFL-ME75485-A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259309OtherAVMED
FL275006OtherWELLCARE
FL7662023OtherAETNA
FL43108OtherBC/BC
FL015146000Medicaid
FL7662023OtherAETNA
FL275006OtherWELLCARE
FL43108TMedicare PIN