Provider Demographics
NPI:1629457890
Name:ALHASAN, MUSTAFA (MBBS)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:ALHASAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CANEBRAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8710
Mailing Address - Country:US
Mailing Address - Phone:832-228-1456
Mailing Address - Fax:
Practice Address - Street 1:22 LLANFAIR RD UNIT 6
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2320
Practice Address - Country:US
Practice Address - Phone:203-663-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA122147002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty