Provider Demographics
NPI:1164603882
Name:SERAG, AHMED A (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:A
Last Name:SERAG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DELAMESA E
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1838
Mailing Address - Country:US
Mailing Address - Phone:714-758-5454
Mailing Address - Fax:
Practice Address - Street 1:15 DELAMESA E
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-1838
Practice Address - Country:US
Practice Address - Phone:714-758-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91166207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164603882Medicaid