Provider Demographics
NPI:1073582201
Name:HUSSAIN, IRSHAD (MD)
Entity Type:Individual
Prefix:
First Name:IRSHAD
Middle Name:
Last Name:HUSSAIN
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 1:4000 MIAMISBURG CENTERVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-7615
Mailing Address - Country:US
Mailing Address - Phone:937-298-8058
Mailing Address - Fax:937-866-6713
Practice Address - Street 1:1126 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2687
Practice Address - Country:US
Practice Address - Phone:937-223-3053
Practice Address - Fax:937-853-0166
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.078335207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH060062815OtherRAILROAD MEDICARE
OH2203556Medicaid
OHH461090Medicare PIN
OH060062815OtherRAILROAD MEDICARE
OH2203556Medicaid