Organization
HARVARDMED FAMILY PRACTICE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIYAM A HUSSAIN M.D. (OWNER)
(919) 639-0100
Entity
Organization
Contact information
Practice address
728 N RALEIGH ST, ANGIER, NC 27501-9134
(919) 639-0100
(919) 639-0313
Mailing address
PO BOX 1110, ANGIER, NC 27501-1110
(919) 639-0100
(919) 639-0313
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200101219
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1291W
BCBS PROVIDER #
NC
05
—
891291W
—
NC
Enumeration date
10/25/2007
Last updated
06/06/2008
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