Healthcare Provider Details

I. General information

NPI: 1477905628
Provider Name (Legal Business Name): MUHAMMAD MASOOD HASSAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW
WASHINGTON DC
20059-0001
US

IV. Provider business mailing address

660 S EUCLID AVE
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 202-806-6306
  • Fax:
Mailing address:
  • Phone: 314-747-8159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMTL003616
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: