Provider Demographics
NPI:1093979197
Name:FATIMA Y. HUSSEIN
Entity Type:Organization
Organization Name:FATIMA Y. HUSSEIN
Other - Org Name:HOLISTIC HEALTH AND WELLNESS CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-899-6660
Mailing Address - Street 1:5625 ALLENTOWN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4521
Mailing Address - Country:US
Mailing Address - Phone:301-899-6660
Mailing Address - Fax:301-899-2210
Practice Address - Street 1:5625 ALLENTOWN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4521
Practice Address - Country:US
Practice Address - Phone:301-899-6660
Practice Address - Fax:301-899-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD55455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC491749Medicare PIN
MD398SMedicare PIN