Basic Information
| Provider Information | |||||||||
| NPI: | 1710162730 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RAZA HASSAN MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 292 | ||||||||
| Address2: | |||||||||
| City: | WAKEFIELD | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028800292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017894971 | ||||||||
| FaxNumber: | 8452079378 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 STONEWAY RD | ||||||||
| Address2: | |||||||||
| City: | WAKEFIELD | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028793969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017894971 | ||||||||
| FaxNumber: | 4017892957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2008 | ||||||||
| LastUpdateDate: | 01/09/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HASSAN | ||||||||
| AuthorizedOfficialFirstName: | RAZA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 4017894971 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 4546 | RI | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.