Provider Demographics
NPI:1942200670
Name:HASSANI, FARIBA (MD)
Entity Type:Individual
Prefix:DR
First Name:FARIBA
Middle Name:
Last Name:HASSANI
Suffix:
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 1:105 W CHURCH STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2251
Mailing Address - Country:US
Mailing Address - Phone:814-445-3812
Mailing Address - Fax:814-444-1852
Practice Address - Street 1:105 W. CHURCH STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2251
Practice Address - Country:US
Practice Address - Phone:814-445-3812
Practice Address - Fax:814-444-1852
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2011-04-05
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
PAMD062097L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA166984301Medicaid
PA122808OtherBLUE CROSS/SHIELD
1526315OtherUMWA
922532OtherAETNA
PA110175670OtherRR MEDICARE
PC854595OtherMAMSI
094423OtherUS HEALTHCARE
PA204916OtherUPMC HEALTH PLAN
PA1502227OtherGATEWAY HEALTH PLAN
PA76478OtherTHREE RIVERS HEALTH PLAN
1526315OtherUMWA
PA1502227OtherGATEWAY HEALTH PLAN