Provider Demographics
NPI:1891771184
Name:HASAN, IRSHAD I (MD)
Entity Type:Individual
Prefix:
First Name:IRSHAD
Middle Name:I
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 1:930 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1333
Mailing Address - Country:US
Mailing Address - Phone:419-666-6682
Mailing Address - Fax:419-666-4340
Practice Address - Street 1:930 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1333
Practice Address - Country:US
Practice Address - Phone:419-662-6682
Practice Address - Fax:419-666-4340
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0978429Medicaid
OH0978429Medicaid
OHH051221Medicare PIN