Provider Demographics
NPI:1184743130
Name:HASSAN, CYRUS (MD)
Entity type:Individual
Prefix:MR
First Name:CYRUS
Middle Name:
Last Name:HASSAN
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 1:106 HAILSHAM PALACE AVENUE
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-0000
Mailing Address - Country:US
Mailing Address - Phone:757-314-7994
Mailing Address - Fax:
Practice Address - Street 1:576 JEFFERSON AVENUE
Practice Address - Street 2:MCDONALD ARMY HEALTH CLINIC
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-0000
Practice Address - Country:US
Practice Address - Phone:757-314-7754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9657171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider