Provider Demographics
NPI:1730868548
Name:HOSSAIN, MAKSUDA (MD)
Entity type:Individual
Prefix:
First Name:MAKSUDA
Middle Name:
Last Name:HOSSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 W GOLDFINCH WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-4554
Mailing Address - Country:US
Mailing Address - Phone:803-586-2321
Mailing Address - Fax:
Practice Address - Street 1:428 NY- 146
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:NY
Practice Address - Zip Code:12009
Practice Address - Country:US
Practice Address - Phone:518-861-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-P122814-01207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine