Provider Demographics
NPI:1942298559
Name:HASAN, NAUSHABA (MD)
Entity Type:Individual
Prefix:DR
First Name:NAUSHABA
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAUSHABA
Other - Middle Name:
Other - Last Name:RIZVI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3500 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-4106
Mailing Address - Country:US
Mailing Address - Phone:215-707-2433
Mailing Address - Fax:215-707-3677
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-1622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68288207R00000X
TNMD29446207R00000X
IL036166472207R00000X
OK43121208M00000X
LA337283208M00000X
TN29446208M00000X
PAMD476047207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000781316CMedicaid
TN3821513Medicaid
TN3821513Medicaid
GA000781316CMedicaid
TNP00461223Medicare PIN
TN3821513Medicare PIN
TNP003885513Medicare PIN