Provider Demographics
NPI:1497739387
Name:AHMED, NUSRAT (MD)
Entity Type:Individual
Prefix:
First Name:NUSRAT
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 1:46 LONE HOLW
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-5530
Mailing Address - Country:US
Mailing Address - Phone:801-572-0133
Mailing Address - Fax:801-539-7050
Practice Address - Street 1:1020 S MAIN ST
Practice Address - Street 2:SUIT #100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-3176
Practice Address - Country:US
Practice Address - Phone:801-572-0133
Practice Address - Fax:801-539-7050
Is Sole Proprietor?:No
Enumeration Date:2005-12-03
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT17416512052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU003OtherEDUCATORS MUTUAL
UTU006OtherINTERMOUNTAIN HEALTH CARE
UTRCAROtherRAILROAD MEDICARE
UTU002OtherDESERET MUTUAL
UTU009OtherCHAMPUS
UTU001OtherBLUE CROSS
UT002200037Medicare PIN
UTU000074326Medicare PIN
UTU006OtherINTERMOUNTAIN HEALTH CARE
UTU002OtherDESERET MUTUAL
UTU009OtherCHAMPUS