Provider Demographics
NPI:1669625281
Name:DHIA HASSANI, M.D.
Entity type:Organization
Organization Name:DHIA HASSANI, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-837-4467
Mailing Address - Street 1:2400 WALES AVE NW
Mailing Address - Street 2:SUITE D
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-0804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 WALES AVE NW
Practice Address - Street 2:SUITE D
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-0804
Practice Address - Country:US
Practice Address - Phone:330-837-4467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35037418208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty