Provider Demographics
NPI:1124040472
Name:HUSAIN, ALI K (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:K
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 1:1802 BRAEBURN DR
Mailing Address - Street 2:SUITE 1310
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7357
Mailing Address - Country:US
Mailing Address - Phone:540-776-2020
Mailing Address - Fax:540-776-2017
Practice Address - Street 1:1802 BRAEBURN DR
Practice Address - Street 2:SUITE 1310
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7357
Practice Address - Country:US
Practice Address - Phone:540-776-2020
Practice Address - Fax:540-776-2017
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00497208G00000X
VA0101255992208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1124040472Medicaid
NC1263KOtherBCBS-NC INDIV
NC891263KMedicaid
VAVVD853AMedicare PIN
NC2280752Medicare ID - Type UnspecifiedNC MEDICARE INDIV
VA1124040472Medicaid