Provider Demographics
NPI:1073501052
Name:AHMAD, SARFRAZ (MD)
Entity Type:Individual
Prefix:
First Name:SARFRAZ
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 1:508 S CHURCH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1702
Mailing Address - Country:US
Mailing Address - Phone:724-547-7212
Mailing Address - Fax:724-547-7278
Practice Address - Street 1:508 S CHURCH ST STE 100
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1702
Practice Address - Country:US
Practice Address - Phone:724-547-7212
Practice Address - Fax:724-547-7278
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059464L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016074200011Medicaid
PAG36492Medicare UPIN
PA894112Medicare PIN