Provider Demographics
NPI:1427285576
Name:HASAN, SYED MUHAMMAD OVAIS (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:MUHAMMAD OVAIS
Last Name:HASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4631 ONONDAGA BLVD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3301
Mailing Address - Country:US
Mailing Address - Phone:315-487-4844
Mailing Address - Fax:315-484-1213
Practice Address - Street 1:4631 ONONDAGA BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3301
Practice Address - Country:US
Practice Address - Phone:315-487-4844
Practice Address - Fax:315-484-1213
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4062207Q00000X
MO2015008266207Q00000X
NY308033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200026613Medicaid