MEDICARE: NAFISA HASAN DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	SC006285	PA

General Provider Information

NPI Number	:	1508153222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAFISA HASAN DPM

Provider Business Mailing Address
First Line	:	1601 WALNUT ST STE 505
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2903
Country	:	US
Telephone Number	:	215-563-2560
Fax Number	:	267-519-9596

Provider Business Practice Location Address
First Line	:	1601 WALNUT ST STE 505
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2903
Country	:	US
Telephone Number	:	215-563-2560
Fax Number	:	267-519-9596

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

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	06/13/2025

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