Provider Demographics
NPI:1932470903
Name:HUSSEIN, ESAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:ESAM
Middle Name:A
Last Name:HUSSEIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:E 11 CALLE 1 RIVERSIDE PARK
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-8594
Mailing Address - Country:US
Mailing Address - Phone:787-635-8980
Mailing Address - Fax:787-780-6841
Practice Address - Street 1:EXT HERMANAS DAVILA
Practice Address - Street 2:56 AVE BETANCES
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5213
Practice Address - Country:US
Practice Address - Phone:787-798-1100
Practice Address - Fax:787-780-6841
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR150142080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR107400Medicare UPIN