MEDICARE: DR. JONATHAN E HASSON M.D., P.A.

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	2086S0129X	Vascular Surgery Physician	045003	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	111135300	OTHER	MD	MEDICAL ASSISTANCE
2	PO1720958	OTHER	PA	RAILROAD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316903206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN E HASSON M.D., P.A.

Provider Business Mailing Address
First Line	:	455 LEWIS AVE
Second Line	:	SUITE 203
City	:	MERIDEN
State	:	CT
Zip	:	06451-2121
Country	:	US
Telephone Number	:	203-634-1900
Fax Number	:	203-634-1895

Provider Business Practice Location Address
First Line	:	455 LEWIS AVE
Second Line	:	SUITE 203
City	:	MERIDEN
State	:	CT
Zip	:	06451-2121
Country	:	US
Telephone Number	:	203-634-1900
Fax Number	:	203-634-1895

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	09/20/2022

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Directions to “ DR. JONATHAN E HASSON M.D., P.A.” Practice Location

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