Healthcare Provider Details

I. General information

NPI: 1659320182
Provider Name (Legal Business Name): NASEEM HAJI HUSSEIN ISMAIL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PATEWOOD DR STE C300
GREENVILLE SC
29615-6324
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-8272
  • Fax: 864-454-2875
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27450
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number27450
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: