Provider Demographics
NPI:1225024672
Name:MOHAMED AHMED, AMIRA M (MD)
Entity Type:Individual
Prefix:
First Name:AMIRA
Middle Name:M
Last Name:MOHAMED AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMIRA
Other - Middle Name:M
Other - Last Name:AHMED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1000 ASYLUM AVENUE
Mailing Address - Street 2:GENGRAS BUILDING, SUITE
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105
Mailing Address - Country:US
Mailing Address - Phone:860-714-4332
Mailing Address - Fax:860-714-8358
Practice Address - Street 1:1000 ASYLUM AVENUE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-714-4332
Practice Address - Fax:860-714-8358
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT054652208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA848902OtherHIGHMARK
PA0017899950001Medicaid
PA0017899950001Medicaid