MEDICARE: FAHEEM HUSSAIN M.D.

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	2085R0202X	Diagnostic Radiology Physician	200200706	NC

General Provider Information

NPI Number	:	1881608594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAHEEM HUSSAIN M.D.

Provider Business Mailing Address
First Line	:	1303 AZALEA CT
Second Line	:	SUITE C
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5765
Country	:	US
Telephone Number	:	843-467-2676
Fax Number	:	843-497-9566

Provider Business Practice Location Address
First Line	:	1303 AZALEA CT
Second Line	:	SUITE C
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5765
Country	:	US
Telephone Number	:	843-467-2676
Fax Number	:	843-497-9566

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	09/29/2016

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