Provider Demographics
NPI:1407957665
Name:HUSARI, AHMED W (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:W
Last Name:HUSARI
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 1:400 C DEPOT ST
Mailing Address - Street 2:PO BOX 303
Mailing Address - City:BURNSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26335
Mailing Address - Country:US
Mailing Address - Phone:304-853-2461
Mailing Address - Fax:304-853-2468
Practice Address - Street 1:7117 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2658
Practice Address - Country:US
Practice Address - Phone:951-784-3045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17283207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0204374000Medicaid
WVE16949Medicare UPIN
WVHU4066985Medicare ID - Type UnspecifiedMEDICARE ID NO.