Healthcare Provider Details

I. General information

NPI: 1881628071
Provider Name (Legal Business Name): ROSHAN ALLY HUSSAIN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 HOSPITAL DR
GRANTSVILLE WV
26147-7100
US

IV. Provider business mailing address

186 HOSPITAL DR
GRANTSVILLE WV
26147-7100
US

V. Phone/Fax

Practice location:
  • Phone: 304-354-9244
  • Fax: 304-462-8000
Mailing address:
  • Phone: 304-354-9244
  • Fax: 304-462-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberWV18796
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: