Provider Demographics
NPI:1891892899
Name:HASAN, SURAYIA T II (MD)
Entity Type:Individual
Prefix:DR
First Name:SURAYIA
Middle Name:T
Last Name:HASAN
Suffix:II
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3624
Mailing Address - Country:US
Mailing Address - Phone:304-255-9444
Mailing Address - Fax:304-255-9447
Practice Address - Street 1:224 PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3624
Practice Address - Country:US
Practice Address - Phone:304-255-9444
Practice Address - Fax:304-255-9447
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001714922OtherBCBS
WVP00392418OtherRAIL ROAD MEDICARE
WV100285OtherDOL
WV1086111OtherUMWA
WV0074965000Medicaid
WV1039817OtherWORKMANS COMPENSATION
WV110146642Other110146642
WVHA0454746Medicare ID - Type Unspecified
WV1086111OtherUMWA
WVD83508Medicare UPIN