Provider Demographics
NPI:1730346156
Name:TETTEH, HASSAN A (MD)
Entity type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:A
Last Name:TETTEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 E 94TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1104
Mailing Address - Country:US
Mailing Address - Phone:917-568-8400
Mailing Address - Fax:
Practice Address - Street 1:8081 INNOVATION PARK DR STE 800
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4867
Practice Address - Country:US
Practice Address - Phone:571-472-4600
Practice Address - Fax:571-665-6885
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217604208G00000X, 208600000X
VA0101245216208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery