Provider Demographics
NPI:1659320182
Name:ISMAIL, NASEEM HAJI HUSSSEIN (MD)
Entity Type:Individual
Prefix:
First Name:NASEEM
Middle Name:HAJI HUSSSEIN
Last Name:ISMAIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR STE C300
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6324
Practice Address - Country:US
Practice Address - Phone:864-454-8272
Practice Address - Fax:864-454-2875
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27450207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7203501OtherAETNA
SC576007863063OtherBCBS OF SC
SCP00187707OtherRR MEDICARE
SC274508Medicaid
SC7505846OtherCIGNA
SC7203501OtherAETNA
SCP00187707OtherRR MEDICARE
SCH912633640Medicare PIN