Provider Demographics
NPI:1194790147
Name:ABOUL-HOSN, HUSSEIN (MD)
Entity type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:
Last Name:ABOUL-HOSN
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:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-0517
Mailing Address - Country:US
Mailing Address - Phone:570-450-6200
Mailing Address - Fax:570-450-6207
Practice Address - Street 1:BELLEFONTE MEDICAL CLINIC
Practice Address - Street 2:527 WILLOWBANK ST
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823
Practice Address - Country:US
Practice Address - Phone:814-353-3337
Practice Address - Fax:814-353-3327
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0347770E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010519440004Medicaid
PA0010519440004Medicaid
PAB41443Medicare UPIN