Basic Information
| Provider Information | |||||||||
| NPI: | 1265094940 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUSSIN | ||||||||
| FirstName: | AHMED | ||||||||
| MiddleName: | MOHAMED BIDER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WOLFEBORO | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038944411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035697500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 240 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WOLFEBORO | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038944411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035697500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2019 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 280948 | MA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 22722 | NH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.