Provider Demographics
NPI:1003844911
Name:AHMAD, MOBASHAR (MD)
Entity Type:Individual
Prefix:
First Name:MOBASHAR
Middle Name:
Last Name:AHMAD
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 1:1110 ELDEN ST # A
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5529
Mailing Address - Country:US
Mailing Address - Phone:703-707-3707
Mailing Address - Fax:703-707-9010
Practice Address - Street 1:1110 ELDEN ST # A
Practice Address - Street 2:SUITE 102
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5529
Practice Address - Country:US
Practice Address - Phone:703-707-3707
Practice Address - Fax:703-707-9010
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049338207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA386123OtherANTHEM BC/BS
VA5966669OtherAETNA PPO
VAG82400001OtherCAREFIRST BC/BS
VAG82400001OtherCAREFIRST BC/BS