Provider Demographics
NPI:1801523329
Name:HASSAN, MOHAMAD ATA
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:ATA
Last Name:HASSAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 MAGEE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-4715
Mailing Address - Country:US
Mailing Address - Phone:215-607-0684
Mailing Address - Fax:
Practice Address - Street 1:637 MAGEE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-4715
Practice Address - Country:US
Practice Address - Phone:215-607-0684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver