Provider Demographics
NPI:1770747032
Name:YUSSUF, ISMAEL IDRIS (MD)
Entity type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:IDRIS
Last Name:YUSSUF
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:PO BOX 1309
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-0309
Mailing Address - Country:US
Mailing Address - Phone:616-821-8972
Mailing Address - Fax:
Practice Address - Street 1:1310 SOUTHERN AVE SE DEPT OF
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4623
Practice Address - Country:US
Practice Address - Phone:540-994-8100
Practice Address - Fax:540-994-8494
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53863208M00000X, 208M00000X
VA0101255853207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
683750684Medicare PIN