# HARVARDMED FAMILY PRACTICE, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295914307
- **Authorized official:** DR. MARIYAM A HUSSAIN M.D. (OWNER)
- **Authorized official phone:** (919) 639-0100

## Contact information

- **Practice address:** 728 N RALEIGH ST, ANGIER, NC 27501-9134
- **Practice address phone:** (919) 639-0100
- **Practice address fax:** (919) 639-0313
- **Mailing address:** PO BOX 1110, ANGIER, NC 27501-1110
- **Mailing address phone:** (919) 639-0100
- **Mailing address fax:** (919) 639-0313

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 200101219 | NC | Yes |

## Other

- **Enumeration date:** 10/25/2007
- **Last updated:** 06/06/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1291W | BCBS PROVIDER \# | NC |
| 05 | — | 891291W | — | NC |