Provider Demographics
NPI:1881628071
Name:HUSSAIN, ROSHAN ALLY (MD)
Entity type:Individual
Prefix:DR
First Name:ROSHAN
Middle Name:ALLY
Last Name:HUSSAIN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26147-7100
Mailing Address - Country:US
Mailing Address - Phone:304-354-9244
Mailing Address - Fax:304-462-8000
Practice Address - Street 1:186 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26147-7100
Practice Address - Country:US
Practice Address - Phone:304-354-9244
Practice Address - Fax:304-462-8000
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV18796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0054730000Medicaid
WV0054730000Medicaid
WV2033441Medicare PIN
WV2033431Medicare PIN
WV4014881Medicare ID - Type Unspecified