Provider Demographics
NPI:1417947516
Name:AHMED, ABDUL RAZZAQUE (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:RAZZAQUE
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 1:697 CAMBRIDGE ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2897
Mailing Address - Country:US
Mailing Address - Phone:617-562-1040
Mailing Address - Fax:617-562-1047
Practice Address - Street 1:697 CAMBRIDGE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2897
Practice Address - Country:US
Practice Address - Phone:617-562-1040
Practice Address - Fax:617-562-1047
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58320207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA26705OtherFALLON HEALTH PLAN
38404OtherCIGNA HEALTHCARE
0300099OtherUNITED HEALTHCARE
053820OtherTUFTS SECURE HORIZONS
J08437OtherBCBS MA
0080243OtherAETNA US HEALTHCARE
401193OtherHPHC
401193OtherHARVARD PILGRIM HEALTH
0080243OtherAETNA US HEALTHCARE
P00068876Medicare ID - Type UnspecifiedRAILROAD MEDICARE
38404OtherCIGNA HEALTHCARE