Provider Demographics
NPI:1043201817
Name:ASHTAR, ED (MD, FACP)
Entity Type:Individual
Prefix:
First Name:ED
Middle Name:
Last Name:ASHTAR
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15225 SHADY GROVE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3254
Mailing Address - Country:US
Mailing Address - Phone:240-477-6620
Mailing Address - Fax:240-477-6495
Practice Address - Street 1:15225 SHADY GROVE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3254
Practice Address - Country:US
Practice Address - Phone:240-477-6620
Practice Address - Fax:240-477-6495
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0060000207R00000X
PAMD435022207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G80010Medicare UPIN
015668I06Medicare ID - Type Unspecified