Healthcare Provider Details

I. General information

NPI: 1194904409
Provider Name (Legal Business Name): HUMAIRA HUSSAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 E EVESHAM RD STE 102
VOORHEES NJ
08043-1557
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-355-7133
  • Fax: 856-355-7134
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA08296500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD432972
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: