Provider Demographics
NPI:1528142130
Name:HASSAN, RAHMA AHMED (MD)
Entity type:Individual
Prefix:
First Name:RAHMA
Middle Name:AHMED
Last Name:HASSAN
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 1:2555 COURT DR STE 270
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2185
Mailing Address - Country:US
Mailing Address - Phone:704-834-4390
Mailing Address - Fax:704-834-3274
Practice Address - Street 1:2525 COURT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:704-834-2000
Practice Address - Fax:704-834-2500
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244790208M00000X
NC2013-01676208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR440143901Medicaid
NC1528142130Medicaid
NC181YNOtherBCBS
SCNC2012Medicaid