Healthcare Provider Details

I. General information

NPI: 1609718410
Provider Name (Legal Business Name): ALI HASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 HARRY S TRUMAN DR N
LARGO MD
20774-5477
US

IV. Provider business mailing address

2806 CONRAD DR
COLUMBUS OH
43207-3500
US

V. Phone/Fax

Practice location:
  • Phone: 240-677-0021
  • Fax: 240-677-0028
Mailing address:
  • Phone: 614-929-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: