Provider Demographics
NPI:1154422236
Name:KHAWAJA, HUSSAIN A (MD)
Entity type:Individual
Prefix:
First Name:HUSSAIN
Middle Name:A
Last Name:KHAWAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:258 HOOSICK ST STE 107
Mailing Address - Street 2:TRI-CITY CARDIOLOGY CARE, PLLC
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2471
Mailing Address - Country:US
Mailing Address - Phone:518-326-8183
Mailing Address - Fax:518-326-8185
Practice Address - Street 1:258 HOOSICK ST STE 107
Practice Address - Street 2:TRI-CITY CARDIOLOGY CARE, PLLC
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2471
Practice Address - Country:US
Practice Address - Phone:518-326-8183
Practice Address - Fax:518-326-8185
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA75391207RC0000X
NY233540207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03241632Medicaid
VT1018300Medicaid
MA110087294AMedicaid
VT1018300Medicaid
NY03241632Medicaid
CAH51136Medicare UPIN
NYJ400101523Medicare PIN