Basic Information
| Provider Information | |||||||||
| NPI: | 1508868761 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HASAN | ||||||||
| FirstName: | FAYSAL | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 HIGHLAND AVE. | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019702100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787454489 | ||||||||
| FaxNumber: | 9783542085 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 HIGHLAND AVE. | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019702100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787454489 | ||||||||
| FaxNumber: | 9783542085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 39224 | MA | X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 39224 | MA | X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 3023711 | 05 | MA | MEDICAID |