Provider Demographics
NPI:1902811219
Name:HASSANEIN, ASHRAF M (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHRAF
Middle Name:M
Last Name:HASSANEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ASHRAF
Other - Middle Name:M
Other - Last Name:HASSANEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11950 COUNTY ROAD 101
Mailing Address - Street 2:STE 203
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-9332
Mailing Address - Country:US
Mailing Address - Phone:352-430-2580
Mailing Address - Fax:352-430-2651
Practice Address - Street 1:11950 COUNTY ROAD 101
Practice Address - Street 2:STE 203
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-9332
Practice Address - Country:US
Practice Address - Phone:352-430-2580
Practice Address - Fax:352-430-2651
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79632207ZP0102X, 207ND0101X, 207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254328100Medicaid
FL68908OtherBLUE CROSS/BLUE SHIELD
FL254328100Medicaid
FL68908YMedicare PIN