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General NPI Number Information
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NPI Number | 1710162730
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Entity Type | Organization
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Legal Business Name | RAZA HASSAN MD INC
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 105 STONEWAY RD
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City | WAKEFIELD
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State | RI
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Zip | 02879-3969
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Country | US
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Telephone | 401-789-4971
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Fax | 401-789-2957
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Provider Business Mailing Address
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Address Line | PO BOX 292
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City | WAKEFIELD
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State | RI
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Zip | 02880-0292
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Country | US
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Telephone | 401-789-4971
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Fax | 845-207-9378
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. RAZA HASSAN
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Credential | M.D.
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Telephone | 401-789-4971
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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 | 4546
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License Number State | RI
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