Provider Demographics
NPI:1376534305
Name:AHMAD, ABRAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAR
Middle Name:
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 1:2002 BROOKSIDE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4634
Mailing Address - Country:US
Mailing Address - Phone:423-245-6000
Mailing Address - Fax:423-245-6062
Practice Address - Street 1:2002 BROOKSIDE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4634
Practice Address - Country:US
Practice Address - Phone:423-245-6000
Practice Address - Fax:423-245-6062
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237891207RN0300X
TN39737207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4105245OtherBLUECROSS BLUESHIELD
VA010190240Medicaid
TNTN0108OtherJOHN DEERE
TN3330508Medicaid
007704Medicare ID - Type Unspecified
VA007704K71Medicare ID - Type Unspecified
I31532Medicare UPIN
TN3330508Medicare ID - Type Unspecified