Provider Demographics
NPI:1750421285
Name:SURAYIA T HASAN
Entity type:Organization
Organization Name:SURAYIA T HASAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SURAYIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-255-9444
Mailing Address - Street 1:224 PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3624
Mailing Address - Country:US
Mailing Address - Phone:304-255-9444
Mailing Address - Fax:304-225-9447
Practice Address - Street 1:224 PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3624
Practice Address - Country:US
Practice Address - Phone:304-255-9444
Practice Address - Fax:304-225-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVD83508Medicare UPIN
WVSU9303491Medicare ID - Type Unspecified