Provider Demographics
NPI:1679554356
Name:HASSANKHANI, ALVAND (MD)
Entity type:Individual
Prefix:
First Name:ALVAND
Middle Name:
Last Name:HASSANKHANI
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 1:3400 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4238
Mailing Address - Country:US
Mailing Address - Phone:215-662-3000
Mailing Address - Fax:215-662-7011
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4238
Practice Address - Country:US
Practice Address - Phone:215-662-3000
Practice Address - Fax:215-662-7011
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA106032002085N0700X
PAMD4262502085N0700X
NY20219112085N0700X, 2085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2375717Medicaid
NY576T11Medicare PIN
AH0576T110Medicare ID - Type Unspecified
SD7201402Medicaid
34195845111518OtherTRICARE WEST
NY785S1OtherBCBS
NY816T61OtherBCBS
H12945Medicare UPIN
OH2623352Medicaid
NYP00250756OtherRXR MEDICARE