Healthcare Provider Details

I. General information

NPI: 1437342714
Provider Name (Legal Business Name): SULAIMAN B HASAN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 CHESTERFIELD AVE SUITE 307
CHARLESTON WV
25304-1069
US

IV. Provider business mailing address

2345 CHESTERFIELD AVE SUITE 307
CHARLESTON WV
25304-1069
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-5126
  • Fax: 304-720-5128
Mailing address:
  • Phone: 304-720-5126
  • Fax: 304-720-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberWV18795
License Number StateWV

VIII. Authorized Official

Name: SULAIMAN B HASAN
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 304-720-5126