Provider Demographics
NPI:1932214137
Name:BOUHUSSEIN, NAIM EZZAT (MD)
Entity type:Individual
Prefix:DR
First Name:NAIM
Middle Name:EZZAT
Last Name:BOUHUSSEIN
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:PO BOX 896199
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-1845
Mailing Address - Country:US
Mailing Address - Phone:833-936-1364
Mailing Address - Fax:605-942-7505
Practice Address - Street 1:738 BRYANT ST
Practice Address - Street 2:SUITE A
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-4189
Practice Address - Country:US
Practice Address - Phone:704-873-1180
Practice Address - Fax:704-873-1116
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600461207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8917048Medicaid
NC8917048Medicaid
2225410Medicare PIN
2225410AMedicare PIN
P00454273Medicare PIN