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General NPI Number Information
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NPI Number | 1295914307
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Entity Type | Organization
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Legal Business Name | HARVARDMED FAMILY PRACTICE, INC
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 728 N RALEIGH ST
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City | ANGIER
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State | NC
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Zip | 27501-9134
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Country | US
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Telephone | 919-639-0100
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Fax | 919-639-0313
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Provider Business Mailing Address
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Address Line | PO BOX 1110
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City | ANGIER
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State | NC
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Zip | 27501-1110
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Country | US
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Telephone | 919-639-0100
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Fax | 919-639-0313
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIYAM A HUSSAIN
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Credential | M.D.
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Telephone | 919-639-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200101219
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License Number State | NC
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