Provider Demographics
NPI:1881608594
Name:HUSSAIN, FAHEEM (MD)
Entity type:Individual
Prefix:
First Name:FAHEEM
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FAHEEM
Other - Middle Name:HYDERI
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1303 AZALEA CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5765
Mailing Address - Country:US
Mailing Address - Phone:843-467-2676
Mailing Address - Fax:843-497-9566
Practice Address - Street 1:1303 AZALEA CT
Practice Address - Street 2:SUITE C
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5765
Practice Address - Country:US
Practice Address - Phone:843-467-2676
Practice Address - Fax:843-497-9566
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002007062085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCU202AMedicare PIN