Provider Demographics
NPI:1891744389
Name:HASAN, EMAD M (MD)
Entity Type:Individual
Prefix:DR
First Name:EMAD
Middle Name:M
Last Name:HASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:M
Other - Last Name:HASAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 TRENT DRIVE BLUE ZONE DUMC BOX 3807
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-684-7777
Mailing Address - Fax:919-681-1037
Practice Address - Street 1:200 TRENT DRIVE BLUE ZONE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-1009
Practice Address - Country:US
Practice Address - Phone:919-684-7777
Practice Address - Fax:919-681-1037
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-6279207T00000X
MO2006034007207T00000X
IA37590207T00000X
NC2021-03404207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207599507Medicaid
MO769167OtherHEALTHLINK
MO962161871Medicare PIN
MO962165236Medicare PIN
IAP00758574Medicare PIN
I66006Medicare UPIN
IAI0923102Medicare PIN
MO769167OtherHEALTHLINK
MO207599507Medicaid