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General NPI Number Information
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NPI Number | 1629709837
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Entity Type | Individual
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Provider Name | MASHTURA HASAN MD
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Gender | Female
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Dates
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Enumeration Date | 06/19/2022
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Last Update Date | 06/19/2022
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Provider Practice Location Address
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Address Line | 96 JONATHAN LUCAS ST
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City | CHARLESTON
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State | SC
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Zip | 29425-8900
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Country | US
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Telephone | 843-792-4638
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Fax |
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Provider Business Mailing Address
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Address Line | 40 BEE ST APT 326
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City | CHARLESTON
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State | SC
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Zip | 29403-5830
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Country | US
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Telephone | 571-314-3004
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | LL88064
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License Number State | SC
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