1942200670 NPI number — DR. FARIBA HASSANI MD

Table of content: DR. FARIBA HASSANI MD (NPI 1942200670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942200670 NPI number — DR. FARIBA HASSANI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASSANI
Provider First Name:
FARIBA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1942200670
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/21/2006
NPI Reactivation Date:
04/03/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 W CHURCH STREET
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15501-2251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-445-3812
Provider Business Mailing Address Fax Number:
814-444-1852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 W. CHURCH STREET
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-2251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-445-3812
Provider Business Practice Location Address Fax Number:
814-444-1852
Provider Enumeration Date:
07/22/2005

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: 207R00000X , with the licence number:  MD062097L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 166984301 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122808 . This is a "BLUE CROSS/SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1526315 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 922532 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110175670 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PC854595 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 094423 . This is a "US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 204916 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1502227 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 76478 . This is a "THREE RIVERS HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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