Provider Demographics
NPI:1083722383
Name:AHAMED, SULTAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SULTAN
Middle Name:
Last Name:AHAMED
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 1:29 GRAVEL ST
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1837
Mailing Address - Country:US
Mailing Address - Phone:860-608-5810
Mailing Address - Fax:860-572-3920
Practice Address - Street 1:29 GRAVEL ST
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1837
Practice Address - Country:US
Practice Address - Phone:860-608-5810
Practice Address - Fax:860-572-3920
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT015920208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010015920CT04OtherANTHEM BC BS OF CT
CTD418684OtherOXFORD HEALTH PLANS
CT2V2557OtherHEALTHNET