Provider Demographics
NPI:1417099862
Name:AHMED, RUBINA (MD)
Entity Type:Individual
Prefix:
First Name:RUBINA
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 1:4605 ASHFIELD TER
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2473
Mailing Address - Country:US
Mailing Address - Phone:315-218-6970
Mailing Address - Fax:
Practice Address - Street 1:2700 BELLEVUE AVE
Practice Address - Street 2:UPPER LEVEL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3234
Practice Address - Country:US
Practice Address - Phone:315-218-6970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2308072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry