Provider Demographics
NPI:1396191797
Name:AHMED, ANUM (MD)
Entity Type:Individual
Prefix:
First Name:ANUM
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 BURNSIDE AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3579
Mailing Address - Country:US
Mailing Address - Phone:860-263-8266
Mailing Address - Fax:
Practice Address - Street 1:580 BURNSIDE AVE
Practice Address - Street 2:STE 2
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3579
Practice Address - Country:US
Practice Address - Phone:860-263-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT66345207R00000X, 208000000X, 208D00000X
CT198369243208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics