Healthcare Provider Details

I. General information

NPI: 1043622657
Provider Name (Legal Business Name): USAID HASAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2014
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

IV. Provider business mailing address

1683 NOBLE ST
EAST MEADOW NY
11554-5006
US

V. Phone/Fax

Practice location:
  • Phone: 800-749-5191
  • Fax:
Mailing address:
  • Phone: 907-657-6625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number055184
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: