Provider Demographics
NPI:1114970811
Name:AHSANUDDIN, KHAJA MOHAMMED (MD)
Entity Type:Individual
Prefix:DR
First Name:KHAJA
Middle Name:MOHAMMED
Last Name:AHSANUDDIN
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 1:113B FOOTHILLS DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5152
Mailing Address - Country:US
Mailing Address - Phone:828-433-5899
Mailing Address - Fax:828-437-4443
Practice Address - Street 1:113B FOOTHILLS DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5152
Practice Address - Country:US
Practice Address - Phone:828-433-5899
Practice Address - Fax:828-437-4443
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC287252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016P5OtherGROUP ID NUMBER WITH BCBS
NC10439OtherINDIVIDUAL ID # WITH BCBS
NC8910439Medicaid
NC8910439Medicaid
NC203423Medicare PIN