Provider Demographics
NPI:1386716512
Name:SHABIH HASAN MD PC
Entity type:Organization
Organization Name:SHABIH HASAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHABIH
Authorized Official - Middle Name:
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-787-7638
Mailing Address - Street 1:722 GRANT ST
Mailing Address - Street 2:STE. F
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4532
Mailing Address - Country:US
Mailing Address - Phone:703-787-7638
Mailing Address - Fax:703-787-7654
Practice Address - Street 1:722 GRANT ST
Practice Address - Street 2:STE. F
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4532
Practice Address - Country:US
Practice Address - Phone:703-787-7638
Practice Address - Fax:703-787-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056360174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007115873Medicaid
VA490924Medicare PIN
VAG05159Medicare UPIN