Provider Demographics
NPI:1982695649
Name:YASIN, GHOUS A (MD)
Entity Type:Individual
Prefix:DR
First Name:GHOUS
Middle Name:A
Last Name:YASIN
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 1:277 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-4667
Mailing Address - Country:US
Mailing Address - Phone:716-690-2291
Mailing Address - Fax:716-690-2369
Practice Address - Street 1:277 DIVISION ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-4667
Practice Address - Country:US
Practice Address - Phone:716-690-2291
Practice Address - Fax:716-690-2369
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01927971Medicaid
NY01927971Medicaid
NYDD4757Medicare ID - Type Unspecified