Provider Demographics
NPI:1164424982
Name:AHMED, FAROOQUE (MD)
Entity Type:Individual
Prefix:
First Name:FAROOQUE
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:PO BOX 920195
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-0004
Mailing Address - Country:US
Mailing Address - Phone:915-206-2150
Mailing Address - Fax:915-206-2151
Practice Address - Street 1:11331 JAMES WATT DR BLDG 100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6401
Practice Address - Country:US
Practice Address - Phone:915-206-2150
Practice Address - Fax:915-206-2151
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07840900207R00000X
TXN5525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0054119Medicaid
NM71120840Medicaid
TX8DZ238OtherBC/BS
TX294773YSXZMedicare PIN
NJH93704Medicare UPIN
NM71120840Medicaid
NM71120840Medicaid