Provider Demographics
NPI:1306562350
Name:HUSSEN, ABDULFATAH
Entity type:Individual
Prefix:
First Name:ABDULFATAH
Middle Name:
Last Name:HUSSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 MAIN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-1433
Mailing Address - Country:US
Mailing Address - Phone:240-330-0209
Mailing Address - Fax:
Practice Address - Street 1:99 FLORENCE ST APT 519
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3956
Practice Address - Country:US
Practice Address - Phone:240-330-0209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver