Healthcare Provider Details

I. General information

NPI: 1669466926
Provider Name (Legal Business Name): HASHIM MOHAMMAD YUSUFZAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: MOHAMMAD HASHIM YUSUFZAI

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 MAPLE ST
DUNCAN FALLS OH
43734-9751
US

IV. Provider business mailing address

PO BOX 308
DUNCAN FALLS OH
43734-0308
US

V. Phone/Fax

Practice location:
  • Phone: 740-674-5020
  • Fax: 740-674-5080
Mailing address:
  • Phone: 740-674-5020
  • Fax: 740-674-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35053716
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101237172
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: