Healthcare Provider Details

I. General information

NPI: 1881608594
Provider Name (Legal Business Name): FAHEEM HUSSAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FAHEEM HYDERI HUSSAIN M.D.

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 AZALEA CT SUITE C
MYRTLE BEACH SC
29577-5765
US

IV. Provider business mailing address

1303 AZALEA CT SUITE C
MYRTLE BEACH SC
29577-5765
US

V. Phone/Fax

Practice location:
  • Phone: 843-467-2676
  • Fax: 843-497-9566
Mailing address:
  • Phone: 843-467-2676
  • Fax: 843-497-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number200200706
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: