Provider Demographics
NPI:1841610961
Name:HASE, NAOMASA (DO)
Entity type:Individual
Prefix:
First Name:NAOMASA
Middle Name:
Last Name:HASE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N 2ND AVE APT 734
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-3519
Mailing Address - Country:US
Mailing Address - Phone:678-296-3805
Mailing Address - Fax:
Practice Address - Street 1:1942 ATKINSON RD STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5004
Practice Address - Country:US
Practice Address - Phone:678-775-0600
Practice Address - Fax:678-377-5284
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.146733207V00000X
WAOP61416149207V00000X
TXT3632207V00000X
GA89751207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2241140Medicaid