MEDICARE: HUSSAIN A KHAWAJA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	A75391	CA
2	207RC0000X	Cardiovascular Disease Physician	233540	NY
3	207RI0011X	Interventional Cardiology Physician	233540	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154422236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUSSAIN A KHAWAJA MD

Provider Business Mailing Address
First Line	:	258 HOOSICK ST STE 107
Second Line	:	TRI-CITY CARDIOLOGY CARE, PLLC
City	:	TROY
State	:	NY
Zip	:	12180-2471
Country	:	US
Telephone Number	:	518-326-8183
Fax Number	:	518-326-8185

Provider Business Practice Location Address
First Line	:	258 HOOSICK ST STE 107
Second Line	:	TRI-CITY CARDIOLOGY CARE, PLLC
City	:	TROY
State	:	NY
Zip	:	12180-2471
Country	:	US
Telephone Number	:	518-326-8183
Fax Number	:	518-326-8185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	06/17/2014

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