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General NPI Number Information
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NPI Number | 1053324962
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Entity Type | Individual
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Provider Name | HASSAN KASSAMALI M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 02/14/2013
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Provider Practice Location Address
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Address Line | 17 FONTANA LN SUITE 101
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City | BALTIMORE
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State | MD
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Zip | 21237-3042
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Country | US
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Telephone | 410-687-0000
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Fax | 410-391-8656
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Provider Business Mailing Address
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Address Line | 17 FONTANA LN SUITE 101 & 103
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City | ROSEDALE
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State | MD
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Zip | 21237-3042
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Country | US
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Telephone | 410-687-0000
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Fax | 410-391-8656
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D0046126
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License Number State | MD
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