Provider Demographics
NPI:1972708972
Name:HASSAN H GHAZAL MD
Entity type:Organization
Organization Name:HASSAN H GHAZAL MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEMATOLOGIST/ONCOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GHAZAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-439-2239
Mailing Address - Street 1:200 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 3-0
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9466
Mailing Address - Country:US
Mailing Address - Phone:606-439-2239
Mailing Address - Fax:606-439-3096
Practice Address - Street 1:200 MEDICAL CENTER DR STE 3O
Practice Address - Street 2:PROFESSIONAL OFFICE BUILDING
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9478
Practice Address - Country:US
Practice Address - Phone:606-439-2239
Practice Address - Fax:606-439-3096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33691174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64336910Medicaid
KY65938136Medicaid
KY0715401Medicare ID - Type UnspecifiedPROVIDER NUMBER
KY7154Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
KY65938136Medicaid