Provider Demographics
NPI:1447230859
Name:HABIB, AHMED A (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:A
Last Name:HABIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AHMED
Other - Middle Name:A
Other - Last Name:HABIBULLAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:311 S 15TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1874
Mailing Address - Country:US
Mailing Address - Phone:740-623-4481
Mailing Address - Fax:740-622-0636
Practice Address - Street 1:311 S 15TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1873
Practice Address - Country:US
Practice Address - Phone:740-623-4481
Practice Address - Fax:740-622-0636
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101538207R00000X, 207RC0000X
OH35.127782207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0158835Medicaid
MO506069004Medicaid
OHH395540Medicare PIN
MO001013765Medicare PIN
MO506069004Medicaid