Provider Demographics
NPI:1255309779
Name:WARDEH, AHMAD (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:WARDEH
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 1:7 ANTHRA PLAZA CTR
Mailing Address - Street 2:
Mailing Address - City:RANSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:17866-4199
Mailing Address - Country:US
Mailing Address - Phone:570-644-0988
Mailing Address - Fax:570-644-0945
Practice Address - Street 1:7 ANTHRA PLAZA CTR
Practice Address - Street 2:
Practice Address - City:RANSHAW
Practice Address - State:PA
Practice Address - Zip Code:17866-4199
Practice Address - Country:US
Practice Address - Phone:570-644-0988
Practice Address - Fax:570-644-0945
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068460L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017615910005Medicaid
PA0017615910005Medicaid
PAG98921Medicare UPIN
PA0017615910005Medicaid