Basic Information
| Provider Information | |||||||||
| NPI: | 1891887923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUSSAIN | ||||||||
| FirstName: | KHWAJA | ||||||||
| MiddleName: | AHMED | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 SOUTHWOOD DR | ||||||||
| Address2: | FAMILY MEDICINE | ||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030631818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035774440 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2300 SOUTHWOOD DR | ||||||||
| Address2: | FAMILY MEDICINE | ||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030631818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035774440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 11/18/2016 | ||||||||
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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 | 207Q00000X | 257349 | MA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 13159 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30206346 | 05 | NH | MEDICAID |