Provider Demographics
NPI:1093796310
Name:AHMED, MASOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:MASOOD
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 1:2 BERNARDINE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4404
Mailing Address - Country:US
Mailing Address - Phone:757-565-0600
Mailing Address - Fax:757-806-6345
Practice Address - Street 1:860 OMNI BLVD
Practice Address - Street 2:STE 303
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4434
Practice Address - Country:US
Practice Address - Phone:757-232-8769
Practice Address - Fax:757-232-8875
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07941400207R00000X, 208D00000X
VA0101250116207RC0000X, 207RI0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAGC1100Medicare PIN
NJI40284Medicare UPIN
NJ093844Medicare ID - Type Unspecified