=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821093865
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERIF HASSAN M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9831 GREENBELT RD STE 103
-----------------------------------------------------
City | LANHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20706-6224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-277-3555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 615
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20735-0615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-277-3555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | D50862
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------