1386859205 NPI number — DR. MAZEN HASAN MD

Table of content: DR. MAZEN HASAN MD (NPI 1386859205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386859205 NPI number — DR. MAZEN HASAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASAN
Provider First Name:
MAZEN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386859205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLACKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24060-7023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-552-1353
Provider Business Mailing Address Fax Number:
540-443-0535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
83 HILLCREST DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PUNXSUTAWNEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15767-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-938-3503
Provider Business Practice Location Address Fax Number:
814-938-4525
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  0101271162 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com