Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 00497 | NC |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 0101255992 | VA |
NPI | 1124040472 |
---|---|
Provider Name | Ali K Husain |
First Address | Salem, VA 24153-7357 |
Second Address | Salem, VA 24153-7357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 18/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1124040472 | (05) | VA |
1263K | BCBS-NC INDIV (01) | NC |
891263K | (05) | NC |
F06677 | (02) | NC |