Basic Information
| Provider Information | |||||||||
| NPI: | 1841502275 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABOU HUSSEIN | ||||||||
| FirstName: | AHMED | ||||||||
| MiddleName: | KAMEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3998 RED LION RD | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191141445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156125250 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 DELLWOOD ST S | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550081920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7636898700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT196327 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 56782 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 106899 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | MD457306 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 102690755 | 05 | PA | MEDICAID |