Healthcare Provider Details

I. General information

NPI: 1649266016
Provider Name (Legal Business Name): BABAR HASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 PHILADELPHIA DR SUITE 4505
DAYTON OH
45406-1813
US

IV. Provider business mailing address

2222 PHILADELPHIA DR SUITE 4505
DAYTON OH
45406-1813
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-4363
  • Fax: 937-734-4181
Mailing address:
  • Phone: 937-734-4363
  • Fax: 937-734-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01050191A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number059665
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.123222
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: