Provider Demographics
NPI:1558351411
Name:AHMED, AITEZAZ UDDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:AITEZAZ
Middle Name:UDDIN
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 1:2210 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2419
Mailing Address - Country:US
Mailing Address - Phone:575-256-2030
Mailing Address - Fax:585-256-2037
Practice Address - Street 1:2210 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2419
Practice Address - Country:US
Practice Address - Phone:575-256-2030
Practice Address - Fax:585-256-2037
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216803207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF39820Medicare UPIN
NYRA7109Medicare ID - Type Unspecified