Provider Demographics
NPI:1154633477
Name:KUDSI, HUSSAM (MD)
Entity Type:Individual
Prefix:
First Name:HUSSAM
Middle Name:
Last Name:KUDSI
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 1:434 GREENE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-5613
Mailing Address - Country:US
Mailing Address - Phone:817-341-2660
Mailing Address - Fax:
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:SUITE 235
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1445
Practice Address - Country:US
Practice Address - Phone:215-632-3630
Practice Address - Fax:215-632-3544
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430344208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30092324OtherKEYSTONE MERCY
PA3798261000OtherKEYSTONE IBC
PA46749MD430344OtherHEALTH PARTNERS
PA6577180OtherAETNA HMO
PA1025134380001Medicaid
PA2520599OtherHIGHMARK BLUE SHIELD
PA188793RLTMedicare PIN