Provider Demographics
NPI:1841358801
Name:HUSSAIN, MAHRUKH MUSHARRAF (MD)
Entity type:Individual
Prefix:DR
First Name:MAHRUKH
Middle Name:MUSHARRAF
Last Name:HUSSAIN
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:PPQA MEDICARE COMPLIANCE UNIT 6 WEST
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:655 WATKINS MILL RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3301
Practice Address - Country:US
Practice Address - Phone:240-632-4825
Practice Address - Fax:240-632-4826
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD060050207R00000X
VA0101234444207RH0003X
DCMD034357207RH0003X
MDD0060050207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H84925Medicare UPIN
011780M92Medicare ID - Type Unspecified