Provider Demographics
NPI:1972682219
Name:GHAZAL, HASSAN H (MD)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:H
Last Name:GHAZAL
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 1:200 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 3-O
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9466
Mailing Address - Country:US
Mailing Address - Phone:606-439-2239
Mailing Address - Fax:606-439-3096
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 3-O
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9466
Practice Address - Country:US
Practice Address - Phone:606-439-2239
Practice Address - Fax:606-439-3096
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY000033691207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64336910Medicaid
KY0715401Medicare ID - Type Unspecified
KY64336910Medicaid