Provider Demographics
NPI:1376551879
Name:AHMED, ELIZABETH C (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1450 CHAPEL ST
Mailing Address - Street 2:PRIORITY TESTING CENTER
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4405
Mailing Address - Country:US
Mailing Address - Phone:203-789-3628
Mailing Address - Fax:203-789-3579
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:PRIORITY TESTING CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-3628
Practice Address - Fax:203-789-3579
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT026783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001267831Medicaid
CT2143439OtherAETNA
CT92568497OtherOXFORD
CA010026783CT01OtherANTHEM BLUE SHIELD
CT026783OtherCONNECTICARE
CT08012145OtherRAILROAD MEDICARE
CT0R0175OtherHEALTHNET
CT110010166Medicare PIN
CT001267831Medicaid
CA010026783CT01OtherANTHEM BLUE SHIELD