Provider Demographics
NPI:1003831405
Name:SULTAN, AHMAD ADNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:ADNAN
Last Name:SULTAN
Suffix:
Gender:M
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:PO BOX 8418
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-0418
Mailing Address - Country:US
Mailing Address - Phone:518-793-9820
Mailing Address - Fax:518-793-7517
Practice Address - Street 1:301 HACKETT BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1963
Practice Address - Country:US
Practice Address - Phone:518-793-9820
Practice Address - Fax:518-793-7517
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192492208100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01487030Medicaid
GA250004975Medicare PIN
NY01487030Medicaid