Provider Demographics
NPI:1316903206
Name:HASSON, JONATHAN E (MD, PA)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:E
Last Name:HASSON
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 LEWIS AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2121
Mailing Address - Country:US
Mailing Address - Phone:203-634-1900
Mailing Address - Fax:203-634-1895
Practice Address - Street 1:455 LEWIS AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2121
Practice Address - Country:US
Practice Address - Phone:203-634-1900
Practice Address - Fax:203-634-1895
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0450032086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD111135300OtherMEDICAL ASSISTANCE
PAPO1720958OtherRAILROAD
PA103186179Medicaid
CT001450030Medicaid
PA103186179Medicaid
CT001450030Medicaid
CT770000071Medicare ID - Type Unspecified