Basic Information
| Provider Information | |||||||||
| NPI: | 1932104023 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HONAINY | ||||||||
| FirstName: | HASSAN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6020 RICHMOND HWY | ||||||||
| Address2: | STE 102 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223032157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4433933653 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 ARH LANE, STE 400 | ||||||||
| Address2: | JACKSON RIVER NEPHROLOGY | ||||||||
| City: | LOW MOOR | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408627064 | ||||||||
| FaxNumber: | 5408625727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 03/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 18529 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 0101052321 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 5807477 | 01 | AETNA | OTHER | 005869404 | 05 | VA | MEDICAID | 282210 | 01 | VA | ANTHEM | OTHER | 006099475 | 05 | VA | MEDICAID | 541839718030 | 01 | VA | BS MOUNTAIN STATE | OTHER | 0078034000 | 05 | WV | MEDICAID | 54183971800 | 01 | WV | WV WORKERS COMPENSATION | OTHER | 541839718053 | 01 | WV | BS MOUNTAIN STATE | OTHER |