1245343987 NPI number — DR. AZRA H HUSSAINI M.D.

Table of content: DR. AZRA H HUSSAINI M.D. (NPI 1245343987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245343987 NPI number — DR. AZRA H HUSSAINI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUSSAINI
Provider First Name:
AZRA
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245343987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1416
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLANDVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21022-1416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-497-6927
Provider Business Mailing Address Fax Number:
833-989-0960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11602 GREENSPRING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-497-6927
Provider Business Practice Location Address Fax Number:
833-989-0960
Provider Enumeration Date:
08/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D52913 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D52913 . This is a "LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: M44595 . This is a "CDS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".