Healthcare Provider Details

I. General information

NPI: 1437370012
Provider Name (Legal Business Name): HASHIBUL HANNAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 SOUTH 54TH STREET
PHILADELPHIA PA
19143
US

IV. Provider business mailing address

12 GILL STREET SUITE 3000
WOBURN MA
01801
US

V. Phone/Fax

Practice location:
  • Phone: 215-748-9000
  • Fax:
Mailing address:
  • Phone: 781-937-4545
  • Fax: 781-937-4510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD431359
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: