Provider Demographics
NPI:1366657645
Name:AHMAD, ASIF IKRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIF
Middle Name:IKRAM
Last Name:AHMAD
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 1:1734 T ST NW
Mailing Address - Street 2:#2
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-7115
Mailing Address - Country:US
Mailing Address - Phone:810-814-5800
Mailing Address - Fax:
Practice Address - Street 1:1734 T ST NW
Practice Address - Street 2:#2
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-7115
Practice Address - Country:US
Practice Address - Phone:810-814-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV132772085R0202X
MI43010807192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00793429OtherRRMC
DCP01285913OtherRR MEDICARE
OK200466620AMedicaid
DCDU4982OtherRR MEDICARE GROUP NUMBER
CA1366657645Medicaid
OK200466620AMedicaid
NVCO865ZMedicare PIN
DC170408ZFLUMedicare PIN
DCDU4982OtherRR MEDICARE GROUP NUMBER
DCP01285913OtherRR MEDICARE