Provider Demographics
NPI:1073541199
Name:JAHED, IDA (MD)
Entity Type:Individual
Prefix:
First Name:IDA
Middle Name:
Last Name:JAHED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 MILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-7613
Mailing Address - Country:US
Mailing Address - Phone:216-386-7221
Mailing Address - Fax:
Practice Address - Street 1:5555 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-8846
Practice Address - Country:US
Practice Address - Phone:707-538-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH087336207R00000X
OH35-087336207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000558121OtherANTHEM
OH741385OtherBUCKEYE MEDICAID
OH7703850OtherAETNA
OH2673567Medicaid
OH741385OtherBUCKEYE MEDICAID
OH7703850OtherAETNA
OHJA4191822Medicare PIN
OHI57058Medicare UPIN