Provider Demographics
NPI:1003059866
Name:AHSAN, SHAGUFTA (MD)
Entity Type:Individual
Prefix:
First Name:SHAGUFTA
Middle Name:
Last Name:AHSAN
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 1:71 LAFAYETTE LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2535
Mailing Address - Country:US
Mailing Address - Phone:917-808-5942
Mailing Address - Fax:
Practice Address - Street 1:71 LAFAYETTE LN
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2535
Practice Address - Country:US
Practice Address - Phone:917-808-5942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09653300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA802675YEBKMedicare PIN
PA802675YUNMMedicare PIN