Provider Demographics
NPI:1043276918
Name:HUSAIN, ARIF (MD)
Entity Type:Individual
Prefix:
First Name:ARIF
Middle Name:
Last Name:HUSAIN
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 1:235 PINE TOP TRAIL
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017
Mailing Address - Country:US
Mailing Address - Phone:610-217-3284
Mailing Address - Fax:610-419-0350
Practice Address - Street 1:3505 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3071
Practice Address - Country:US
Practice Address - Phone:928-757-8111
Practice Address - Fax:928-757-1199
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046886L2084P0805X
AZ546042084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA260041671OtherRAIL ROAD
PA0015970290008Medicaid
AZ314995Medicaid
PA260045486OtherPALMETTO GBA
F37206Medicare UPIN
AZ314995Medicaid