Basic Information
| Provider Information | |||||||||
| NPI: | 1235259672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HASAN | ||||||||
| FirstName: | ANSUDDIN | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174218 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172174300 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 02/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD432763 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | MD432763 | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1566553 | 01 | PA | FIRST HEALTH | OTHER | 227165 | 01 | PA | UNISON | OTHER | FH0524377 | 01 | PA | DEA | OTHER | 2178745 | 01 | PA | MAMSI | OTHER | 25-1716306 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER | 50087505 | 01 | PA | CAPITAL BLUECROSS (WH) | OTHER | 675442 | 01 | PA | HEALTH AMERICA | OTHER | HA1988417 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 1711126 | 01 | PA | AETNA HMO | OTHER | 25-1716306 | 01 | PA | GREATWEST | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | 9925091 | 01 | PA | AETNA NON-HMO | OTHER | MD432763 | 01 | PA | LICENSE | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | 102018553 0002 | 05 | PA | MEDICAID | 1567150 | 01 | PA | GATEWAY | OTHER | 25-1716306 | 01 | PA | INFORMED | OTHER | 50073016 | 01 | PA | CAPITAL BLUECROSS (HOFC) | OTHER | G920-0084/25RXCU | 01 | PA | CAREFIRST | OTHER | P00468807 | 01 | PA | RAILROAD MEDICARE | OTHER | 120420410 | 01 | PA | DEPT OF LABOR | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER |