Healthcare Provider Details

I. General information

NPI: 1346226453
Provider Name (Legal Business Name): HOSSAN A HASSAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 CHERAW ST.
BENNETTSVILLE SC
29512
US

IV. Provider business mailing address

PO BOX 918
BENNETTSVILLE SC
29512-0918
US

V. Phone/Fax

Practice location:
  • Phone: 843-454-0442
  • Fax: 843-777-6871
Mailing address:
  • Phone: 843-454-0841
  • Fax: 815-654-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD23135
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2017-00656
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23135
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: