Provider Demographics
NPI:1093809295
Name:HUSSAIN, WASEEM (MD)
Entity Type:Individual
Prefix:
First Name:WASEEM
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 1:8116 GOOD LUCK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3502
Mailing Address - Country:US
Mailing Address - Phone:240-241-7474
Mailing Address - Fax:301-731-5733
Practice Address - Street 1:8116 GOOD LUCK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3502
Practice Address - Country:US
Practice Address - Phone:240-241-7474
Practice Address - Fax:301-731-5733
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054272207Q00000X
IL336060890207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH04462Medicare UPIN
MDH04662Medicare UPIN