Provider Demographics
NPI:1437272846
Name:AHMAD, BASHIR (PA)
Entity Type:Individual
Prefix:MR
First Name:BASHIR
Middle Name:
Last Name:AHMAD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 HARWICH TER
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6911
Mailing Address - Country:US
Mailing Address - Phone:240-993-9833
Mailing Address - Fax:
Practice Address - Street 1:3720 MARTIN LUTHER KING AVENUE,SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON,
Practice Address - State:DC
Practice Address - Zip Code:20032
Practice Address - Country:US
Practice Address - Phone:202-279-1800
Practice Address - Fax:202-279-4943
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA73363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant