Provider Demographics
NPI:1477653137
Name:HOSSAIN, MOHAMMAD DELBAHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:DELBAHAR
Last Name:HOSSAIN
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 1:3214 CHARLES B ROOT WYND
Mailing Address - Street 2:SUITE 213
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5440
Mailing Address - Country:US
Mailing Address - Phone:919-781-8780
Mailing Address - Fax:919-781-8782
Practice Address - Street 1:3214 CHARLES B ROOT WYND
Practice Address - Street 2:SUITE 213
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5440
Practice Address - Country:US
Practice Address - Phone:919-781-8780
Practice Address - Fax:919-781-8782
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701768207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2261904EOtherSECONDARY MEDICARE
NC891128NMedicaid
NC9701768OtherMEDICAL LICENSE
NC891128NMedicaid
NC9701768OtherMEDICAL LICENSE