Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 2019-01777 | NC |
Y | 111NI0900X | Internist | 2019-01777 | NC |
N | 207R00000X | Internist | MT211750 | PA |
N | 111NI0900X | Internist | MT211750 | PA |
NPI | 1003267006 |
---|---|
Provider Name | Ali Hussain |
First Address | Elizabeth City, NC 27909-3473 |
Second Address | Elizabeth City, NC 27909-3473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2016 |
Last Update Date | 12/07/2019 |