MEDICARE: DR. IMRAN HASNUDDIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	D0100648	MD

General Provider Information

NPI Number	:	1225691355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IMRAN HASNUDDIN

Provider Business Mailing Address
First Line	:	7 GLEN WILTON CT
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21228-2506
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6660 SECURITY BLVD STE 1
Second Line	:
City	:	WOODLAWN
State	:	MD
Zip	:	21207-4012
Country	:	US
Telephone Number	:	443-929-4420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2019
Last Update Date	:	07/26/2024

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Directions to “ DR. IMRAN HASNUDDIN ” Practice Location

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