Provider Demographics
NPI:1376513838
Name:AHMED, MOHAMMAD A (DO)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:A
Last Name:AHMED
Suffix:
Gender:M
Credentials:DO
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 65274
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28265-0274
Mailing Address - Country:US
Mailing Address - Phone:800-377-8721
Mailing Address - Fax:304-523-2241
Practice Address - Street 1:921 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-2020
Practice Address - Country:US
Practice Address - Phone:419-673-0761
Practice Address - Fax:419-673-9366
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6326-A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2047976Medicaid
OH000000368185OtherBLUECROSS BLUESHIELD
G73070Medicare UPIN
OHAH0836593Medicare ID - Type Unspecified