Basic Information
| Provider Information | |||||||||
| NPI: | 1801870027 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAFIA | ||||||||
| FirstName: | HASS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 820933 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191820933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159269010 | ||||||||
| FaxNumber: | 2152268285 | ||||||||
| Practice Location | |||||||||
| Address1: | 1364 E HUNTING PARK AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152893390 | ||||||||
| FaxNumber: | 2152897072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 09/11/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD 030026L | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | MD030026L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0118054 | 01 | PA | AETNA HMO | OTHER | 4084540 | 01 | PA | AETNA PPO | OTHER | 0053803000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 0118036 | 01 | PA | AETNA HMO | OTHER | 017929 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 1572 | 01 | PA | BRAVO HEALTH | OTHER | 000616961 | 05 | PA | MEDICAID | 3Y2562 | 01 | PA | HEALTH NET | OTHER | P00025018 | 01 | PA | RAILROAD MEDICARE | OTHER | 459079 | 01 | PA | COVENTRY HEALTH AMERICA | OTHER | 1026702 | 01 | PA | KEYSTONE MERCY HEALTH | OTHER | 1081808 | 01 | PA | KEYSTONE MERCY HEALTH | OTHER | 0006169610015 | 05 | PA | MEDICAID |