Basic Information
Provider Information
NPI: 1003006636
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HASAN
FirstName: SABA
MiddleName: F
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5544 GREENWICH RD STE 200
Address2:  
City: VIRGINIA BEACH
State: VA
PostalCode: 234626563
CountryCode: US
TelephoneNumber: 7574660089
FaxNumber: 7574668017
Practice Location
Address1: 5544 GREENWICH RD STE 200
Address2:  
City: VIRGINIA BEACH
State: VA
PostalCode: 234626563
CountryCode: US
TelephoneNumber: 7574660089
FaxNumber: 7574668017
Other Information
ProviderEnumerationDate: 07/30/2007
LastUpdateDate: 02/07/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X0101244877VAY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

ID Information
IDTypeStateIssuerDescription
1005534701VASENTARAOTHER
591426205NC MEDICAID
P0081354201VARR MEDICAREOTHER
1005534701VAOPTIMAOTHER
106735105LA MEDICAID
13917801VABCBSOTHER


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