Healthcare Provider Details

I. General information

NPI: 1043626856
Provider Name (Legal Business Name): MARYAM M HASAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6738 W SUNRISE BLVD STE 101
PLANTATION FL
33313-6070
US

IV. Provider business mailing address

6738 W SUNRISE BLVD STE 101
PLANTATION FL
33313-6070
US

V. Phone/Fax

Practice location:
  • Phone: 754-778-6706
  • Fax: 754-778-6935
Mailing address:
  • Phone: 754-778-6706
  • Fax: 754-778-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME161036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: