Provider Demographics
NPI:1740420041
Name:HASAN, OMAIR (MD)
Entity type:Individual
Prefix:DR
First Name:OMAIR
Middle Name:
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 1:8924 E PINNACLE PEAK RD STE G5-535
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3618
Mailing Address - Country:US
Mailing Address - Phone:480-821-9339
Mailing Address - Fax:480-821-9555
Practice Address - Street 1:1930 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7711
Practice Address - Country:US
Practice Address - Phone:480-821-9339
Practice Address - Fax:480-821-9555
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR70455207R00000X
NV14079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1740420041Medicaid
NVFO332ZMedicare PIN