Provider Demographics
NPI:1043216948
Name:AHMED, IMRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:
Last Name:AHMED
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 1:38 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-3210
Mailing Address - Country:US
Mailing Address - Phone:845-333-6500
Mailing Address - Fax:845-333-6501
Practice Address - Street 1:38 CONCORD RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-3210
Practice Address - Country:US
Practice Address - Phone:845-333-6500
Practice Address - Fax:845-333-6501
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1272374OtherEMPIRE UNITED HC
NY01494999Medicaid
NYF51991Medicare UPIN
NY91H85LW281Medicare PIN