Basic Information
| Provider Information | |||||||||
| NPI: | 1104930569 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASSON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 N LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472401327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126634331 | ||||||||
| FaxNumber: | 8126631299 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 N LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472401327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126634331 | ||||||||
| FaxNumber: | 8126631299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 11/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 01044153 | IN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 200127910A | 05 | IN | MEDICAID |