Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 274376 | MA |
NPI | 1043626856 |
---|---|
Provider Name | Maryam M Hasan |
First Address | Springfield, MA 01199-1001 |
Second Address | Springfield, MA 01107-1619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2014 |
Last Update Date | 21/11/2018 |