Provider Demographics
NPI:1053307496
Name:AHMED, MOHAMED (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
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:PO BOX 1040
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21922-1040
Mailing Address - Country:US
Mailing Address - Phone:410-398-0590
Mailing Address - Fax:443-245-3737
Practice Address - Street 1:300 E PULASKI HWY
Practice Address - Street 2:SUIT 106
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6435
Practice Address - Country:US
Practice Address - Phone:410-398-0590
Practice Address - Fax:443-245-3737
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10007449207L00000X, 207LP2900X
DEC1-0010198208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE015435H14Medicare PIN
DE015435Y8JMedicare PIN