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General NPI Number Information
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NPI Number | 1508153032
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Entity Type | Individual
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Provider Name | HASAN ABDUL HOOPER CST, CSA
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Gender | Male
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Dates
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Enumeration Date | 07/05/2011
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Last Update Date | 07/05/2011
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Provider Practice Location Address
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Address Line | 3622 1/2 SUSSEX RD
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City | GWYNN OAK
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State | MD
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Zip | 21207-3817
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Country | US
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Telephone | 646-489-0692
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Fax |
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Provider Business Mailing Address
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Address Line | 3622 1/2 SUSSEX RD
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City | GWYNN OAK
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State | MD
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Zip | 21207-3817
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Country | US
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Telephone | 646-489-0692
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Fax |
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 3431
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 113968
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License Number State | CO
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