Provider Demographics
NPI:1942546221
Name:HASSAN, OHLA (PA-C)
Entity type:Individual
Prefix:
First Name:OHLA
Middle Name:
Last Name:HASSAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 NORTHPORT AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6096
Mailing Address - Country:US
Mailing Address - Phone:207-505-4163
Mailing Address - Fax:207-613-2570
Practice Address - Street 1:116 NORTHPORT AVE STE 112
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6096
Practice Address - Country:US
Practice Address - Phone:207-505-4163
Practice Address - Fax:207-613-2570
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08084363A00000X
MEPA2933363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350351802Medicaid
TX350351803OtherCSHCN