Provider Demographics
NPI:1952325029
Name:HASAN, SYED WAQAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:WAQAR
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 1:7074 GROVE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8658
Mailing Address - Country:US
Mailing Address - Phone:352-540-9335
Mailing Address - Fax:
Practice Address - Street 1:7074 GROVE RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34609-8658
Practice Address - Country:US
Practice Address - Phone:352-540-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME964862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01244727OtherRAILROAD MCR
FLP01244727OtherRAILROAD MCR