Provider Demographics
NPI:1417941949
Name:HUSSAIN, GHULAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GHULAM
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 1:113 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-4407
Mailing Address - Country:US
Mailing Address - Phone:704-735-1441
Mailing Address - Fax:704-735-1472
Practice Address - Street 1:113 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4407
Practice Address - Country:US
Practice Address - Phone:704-735-1441
Practice Address - Fax:704-735-1472
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900546208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1197FOtherBLUE CROSS BLUE SHEILD
NC3386503OtherCIGNA
NC891197FMedicaid
D2618OtherMEDCOST
2121220OtherMAMSI
2121220OtherMAMSI