Provider Demographics
NPI:1104988310
Name:HUSAIN, ZAHID (MD)
Entity type:Individual
Prefix:
First Name:ZAHID
Middle Name:
Last Name:HUSAIN
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 1:150 MUNDY STREET
Mailing Address - Street 2:MAC II BLDG
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702
Mailing Address - Country:US
Mailing Address - Phone:570-824-7117
Mailing Address - Fax:570-825-7610
Practice Address - Street 1:150 MUNDY STREET
Practice Address - Street 2:MAC II BLDG
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-824-7117
Practice Address - Fax:570-825-7610
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD023677E207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0711610Medicaid
PA0042763000OtherINDEPENDENCE BS
PA072067OtherFIRST PRIORITY
PA0042763000OtherINDEPENDENCE BS
PA402444Medicare ID - Type Unspecified