Provider Demographics
NPI:1093765554
Name:AHMED, SYED (MD)
Entity Type:Individual
Prefix:
First Name:SYED
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 1:621 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4437
Mailing Address - Country:US
Mailing Address - Phone:540-899-7766
Mailing Address - Fax:
Practice Address - Street 1:621 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE A
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4437
Practice Address - Country:US
Practice Address - Phone:540-899-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012358112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
084012OtherSENTARA BEHAVIORAL HEALTH
VA010386578Medicaid
52471OtherVALUE OPTIONS
392863OtherMHN
715670OtherNCPPO
VA010386578Medicaid