Provider Demographics
NPI:1154399657
Name:HUSSAIN, SARWAT (MD)
Entity type:Individual
Prefix:DR
First Name:SARWAT
Middle Name:
Last Name:HUSSAIN
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:570-882-3007
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:570-882-3007
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4234932085R0202X
NY234501-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02521988Medicaid
NYP00137705OtherRR MEDICARE PIN
PAP00179469OtherRR MEDICARE PIN
PACC9269OtherRR MEDICARE GROUP
NYCC8362OtherRR MEDICARE GROUP
PA1008365740001Medicaid
PACC9269OtherRR MEDICARE GROUP
PAP00179469OtherRR MEDICARE PIN
E85758Medicare UPIN