Healthcare Provider Details

I. General information

NPI: 1275757742
Provider Name (Legal Business Name): STEPHEN M HASS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 MACCORKLE AVE SE DEPT OF SURGERY WVU
CHARLESTON WV
25304-1210
US

IV. Provider business mailing address

3110 MACCORKLE AVE SE DEPT OF SURGERY WVU
CHARLESTON WV
25304-1210
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-4884
  • Fax: 304-388-4888
Mailing address:
  • Phone: 304-388-4884
  • Fax: 304-388-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number22251
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: