Provider Demographics
NPI:1417791799
Name:HASAN, TAHIRA BINTE (MD)
Entity type:Individual
Prefix:
First Name:TAHIRA
Middle Name:BINTE
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 1:6420 CLAYTON
Mailing Address - Street 2:DEPT. INTERNAL MEDICINE 2ND FLOOR
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1811
Mailing Address - Country:US
Mailing Address - Phone:314-768-8778
Mailing Address - Fax:314-768-7101
Practice Address - Street 1:6420 CLAYTON
Practice Address - Street 2:DEPT. INTERNAL MEDICINE 2ND FLOOR
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1811
Practice Address - Country:US
Practice Address - Phone:314-768-8778
Practice Address - Fax:314-768-7101
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024019296390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program