Provider Demographics
NPI:1083683528
Name:AHMED, IRSHAD (MD)
Entity Type:Individual
Prefix:
First Name:IRSHAD
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 1:2801 BOULEVARD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2323
Mailing Address - Country:US
Mailing Address - Phone:804-524-0524
Mailing Address - Fax:804-524-0520
Practice Address - Street 1:2801 BOULEVARD
Practice Address - Street 2:SUITE B
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2323
Practice Address - Country:US
Practice Address - Phone:804-524-0524
Practice Address - Fax:804-524-0520
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058744207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005867151Medicaid
VA1083683528OtherINDIVIDUAL NPI NUMBER
G36623Medicare UPIN
VA005867151Medicaid