Provider Demographics
NPI:1699218842
Name:HUSSAIN, JAFFER (MD)
Entity Type:Individual
Prefix:
First Name:JAFFER
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 1:104 MARK DR
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-1756
Mailing Address - Country:US
Mailing Address - Phone:252-482-5171
Mailing Address - Fax:252-482-5173
Practice Address - Street 1:104 MARK DR
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-1756
Practice Address - Country:US
Practice Address - Phone:252-482-5171
Practice Address - Fax:252-482-5173
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-04427207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease