Provider Demographics
NPI:1952391849
Name:HUSAIN, AMJAD (MD)
Entity Type:Individual
Prefix:
First Name:AMJAD
Middle Name:
Last Name:HUSAIN
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 1:200 GROTON ROAD
Mailing Address - Street 2:NASHOBA VALLEY HEALTHCARE GROUP
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432
Mailing Address - Country:US
Mailing Address - Phone:978-784-9000
Mailing Address - Fax:
Practice Address - Street 1:200 GROTON ROAD
Practice Address - Street 2:
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432
Practice Address - Country:US
Practice Address - Phone:978-784-9972
Practice Address - Fax:978-772-0015
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219803207R00000X, 207RP1001X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMX8870OtherPTAN 41
MAMX8866OtherPTAN
MA2040361Medicaid
MAMX8870OtherPTAN 41
A36688Medicare ID - Type Unspecified