Provider Demographics
NPI:1275647125
Name:BAYRAKDAR, AHMAD K (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:K
Last Name:BAYRAKDAR
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 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655
Practice Address - Country:US
Practice Address - Phone:508-334-3068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036049153207R00000X
WAMD60903183207RG0100X
DCMD5712207RG0100X
PAMD433241207RG0100X
IN01068653A207RG0100X
OH35.142897207RG0100X
MA291590207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000673602OtherANTHEM PROVIDER NUMBER
IN200992410Medicaid
ILF400101726Medicare UPIN
INM400022748Medicare PIN
INP00880379Medicare PIN