Provider Demographics
NPI:1407877202
Name:AHMED, ANIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIS
Middle Name:
Last Name:AHMED
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 1:505 W MARKET ST
Mailing Address - Street 2:STE 110
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-2344
Mailing Address - Country:US
Mailing Address - Phone:302-854-0626
Mailing Address - Fax:302-752-1500
Practice Address - Street 1:400 DELAWARE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-1718
Practice Address - Country:US
Practice Address - Phone:302-934-1861
Practice Address - Fax:302-934-7318
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00581832084P0800X
DEC1 00052622084P0800X
DEC1-00052622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000867801Medicaid
MD4015720-00Medicaid
MD4015916 00Medicaid
MD4015720 00Medicaid
DE0000916802Medicaid
DE617330Medicare PIN
DE0000867801Medicaid
MD4015720-00Medicaid
MD4015720 00Medicaid
DE0000916802Medicaid
DE000L83J74Medicare ID - Type UnspecifiedINDIVIDUAL
G00274Medicare PIN