Healthcare Provider Details

I. General information

NPI: 1558708941
Provider Name (Legal Business Name): KHALID I. A. HASSAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2013
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 HIGHLAND AVE
WINCHESTER MA
01890-1496
US

IV. Provider business mailing address

41 HIGHLAND AVE
WINCHESTER MA
01890-1496
US

V. Phone/Fax

Practice location:
  • Phone: 781-756-2342
  • Fax:
Mailing address:
  • Phone: 781-756-2342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number273791
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: