Provider Demographics
NPI:1023262672
Name:HUSIC, AMILA (MD)
Entity type:Individual
Prefix:
First Name:AMILA
Middle Name:
Last Name:HUSIC
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 1:6 TSIENNETO RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1584
Mailing Address - Country:US
Mailing Address - Phone:603-434-7444
Mailing Address - Fax:603-434-1733
Practice Address - Street 1:6 TSIENNETO RD
Practice Address - Street 2:SUITE 203
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1584
Practice Address - Country:US
Practice Address - Phone:603-434-7444
Practice Address - Fax:603-434-1733
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16714208600000X
282N00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No282N00000XHospitalsGeneral Acute Care Hospital
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3100935Medicaid
NH3100935Medicaid
NHRAILROAD P01464787Medicare PIN