Healthcare Provider Details

I. General information

NPI: 1891229910
Provider Name (Legal Business Name): AFSHAN HASSAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 08/03/2021
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE ROBERT C. BIRD CLINICAL TRAINING CENTER, 4TH FLOOR
CHARLESTON WV
25304-1227
US

IV. Provider business mailing address

3200 MACCORKLE AVE SE STE B16
CHARLESTON WV
25304-1227
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-5590
  • Fax: 304-388-8238
Mailing address:
  • Phone: 304-388-5848
  • Fax: 304-388-9654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME149100
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number29844
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: