Provider Demographics
NPI:1275165425
Name:AHMED, REHAN
Entity Type:Individual
Prefix:
First Name:REHAN
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6814 TIDDLE WAY
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1365
Mailing Address - Country:US
Mailing Address - Phone:571-426-9880
Mailing Address - Fax:540-371-2046
Practice Address - Street 1:1031 CARE WAY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8425
Practice Address - Country:US
Practice Address - Phone:540-371-7600
Practice Address - Fax:540-371-2046
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA110009724363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant