Provider Demographics
NPI:1124048590
Name:HASAN, NOREEN (MD)
Entity type:Individual
Prefix:DR
First Name:NOREEN
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E MATTHEWS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3120
Mailing Address - Country:US
Mailing Address - Phone:870-207-7555
Mailing Address - Fax:
Practice Address - Street 1:303 E MATTHEWS AVE STE 202
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3120
Practice Address - Country:US
Practice Address - Phone:870-207-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196471207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR191916001Medicaid
AR191916001Medicaid
AR5AJ59Medicare UPIN