Provider Demographics
NPI:1518986454
Name:AHMED, MASUM (MD)
Entity Type:Individual
Prefix:DR
First Name:MASUM
Middle Name:
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 1:230 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1328
Mailing Address - Country:US
Mailing Address - Phone:845-486-2750
Mailing Address - Fax:845-485-2759
Practice Address - Street 1:9 MANSION ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-2309
Practice Address - Country:US
Practice Address - Phone:845-486-3700
Practice Address - Fax:845-486-3727
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2380442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY566BQ1Medicare ID - Type UnspecifiedPROVIDER NUMBBER