Healthcare Provider Details

I. General information

NPI: 1134485220
Provider Name (Legal Business Name): HASAN HAIDERALI DANISH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S CEDAR CREST BLVD
ALLENTOWN PA
18103
US

IV. Provider business mailing address

1240 S CEDAR CREST BLVD
ALLENTOWN PA
18103
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-0767
  • Fax: 610-402-0708
Mailing address:
  • Phone: 610-402-0767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD460520
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: