Provider Demographics
NPI:1114548088
Name:AFZAL, AMMARA (MBBS)
Entity Type:Individual
Prefix:
First Name:AMMARA
Middle Name:
Last Name:AFZAL
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 HAMILTON MASON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8556
Mailing Address - Country:US
Mailing Address - Phone:513-863-6222
Mailing Address - Fax:513-863-6478
Practice Address - Street 1:3145 HAMILTON MASON RD STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011-8556
Practice Address - Country:US
Practice Address - Phone:513-863-6222
Practice Address - Fax:513-863-6478
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-02
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.149080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program