Provider Demographics
NPI:1245301175
Name:JONATHAN E. HASSON, MD, PA
Entity type:Organization
Organization Name:JONATHAN E. HASSON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HASSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:910-417-3396
Mailing Address - Street 1:PO BOX 5568
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-5568
Mailing Address - Country:US
Mailing Address - Phone:910-417-3396
Mailing Address - Fax:
Practice Address - Street 1:921 S LONG DR
Practice Address - Street 2:SUITE 208
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4874
Practice Address - Country:US
Practice Address - Phone:910-417-3396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC346212086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8940404Medicaid
NCFH2000180OtherFIRST CAROLINA CARE
NC40404OtherBCBA
NC1937504OtherCIGNA
NC1937504OtherCIGNA
NC40404OtherBCBA