Provider Demographics
NPI:1033142138
Name:AHSANUDDIN, ASHFAQ (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHFAQ
Middle Name:
Last Name:AHSANUDDIN
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 1:1100 TUNNEL RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-2576
Mailing Address - Country:US
Mailing Address - Phone:828-298-7911
Mailing Address - Fax:828-299-5885
Practice Address - Street 1:1100 TUNNEL ROAD
Practice Address - Street 2:CHARLES GEORGE VAMC- ASHEVILLE
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-1334
Practice Address - Country:US
Practice Address - Phone:828-299-2515
Practice Address - Fax:828-299-5885
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20312207R00000X
NC2008-00231208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1801503000Medicaid
WV317844OtherANTHEM BCBS
WV513111001OtherCIGNA
WV010070244OtherFIRST HEALTH
WV042OtherMTST BCBS
WV110215608OtherRAILROAD MEDICARE
WV134443OtherSOUTHERN HEALTH
WV293968OtherMAMSI
WV7706176OtherAETNA
WV134443OtherSOUTHERN HEALTH
WVAH4035151Medicare ID - Type Unspecified