Provider Demographics
NPI:1619249513
Name:HUSSAIN, MOHAMMAD T (RPH)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:T
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12716 W OLD BALTIMORE RD
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-2020
Mailing Address - Country:US
Mailing Address - Phone:240-423-3401
Mailing Address - Fax:
Practice Address - Street 1:1050 BRENTWOOD RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1000
Practice Address - Country:US
Practice Address - Phone:202-281-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH2863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1629001975Medicaid