Provider Demographics
NPI:1093734667
Name:AHMAD, FUAD R (MD)
Entity Type:Individual
Prefix:
First Name:FUAD
Middle Name:R
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 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6247
Mailing Address - Fax:
Practice Address - Street 1:701 GROVE RD FL 5
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4210
Practice Address - Country:US
Practice Address - Phone:864-455-4411
Practice Address - Fax:864-455-4480
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000170207R00000X, 208M00000X
KY42038207R00000X
IN01060888A208M00000X
SC17894208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC178943Medicaid
SCSC53555019OtherMEDICARE PIN
SCSC53559068OtherMEDICARE PIN
IN200531100Medicaid
IN000000373463OtherBCBS - MARY STREET
IN000000386251OtherBCBS - GATEWAY
NC1093734667Medicaid
KY000000637777OtherANTHEM # WITH CHS, INC.
KY64108798Medicaid
NC890638FMedicaid
INP00251302OtherRR MEDICARE PIN
G18445Medicare UPIN
KY64108798Medicaid
NC1093734667Medicaid