Provider Demographics
NPI:1649239633
Name:HUSSEIN, DIAA ELDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DIAA
Middle Name:ELDIN
Last Name:HUSSEIN
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 1:329B SANFORD DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-2555
Mailing Address - Country:US
Mailing Address - Phone:828-430-9120
Mailing Address - Fax:828-430-9122
Practice Address - Street 1:329B SANFORD DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-2555
Practice Address - Country:US
Practice Address - Phone:828-430-9120
Practice Address - Fax:828-430-9122
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC130U6OtherBCBS
NC89130U6Medicaid
NC200000467OtherNC LICENSE
NCBH4838542OtherDEA
NC201025918OtherTIN
NC130U6OtherBCBS
NC2298083AMedicare ID - Type UnspecifiedMEDICARE
NCG36346Medicare UPIN