Provider Demographics
NPI:1578693917
Name:AHMAD M. MEHDI M.D P.C
Entity Type:Organization
Organization Name:AHMAD M. MEHDI M.D P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:AHAMD
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEHDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-898-5827
Mailing Address - Street 1:100 SYKES ST
Mailing Address - Street 2:PO BOX 68
Mailing Address - City:GROTON
Mailing Address - State:NY
Mailing Address - Zip Code:13073-1231
Mailing Address - Country:US
Mailing Address - Phone:607-898-5827
Mailing Address - Fax:607-898-9726
Practice Address - Street 1:100 SYKES ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:NY
Practice Address - Zip Code:13073-1231
Practice Address - Country:US
Practice Address - Phone:607-898-5827
Practice Address - Fax:607-898-9726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215330-1207Q00000X
NY007106-1363AM0700X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02167100Medicaid
NY01983962Medicaid
NY02055512Medicaid
NYCC0105Medicare ID - Type Unspecified
NY02055512Medicaid
NYBB9151Medicare ID - Type Unspecified
NY01983962Medicaid
NYP04225Medicare UPIN
NY02167100Medicaid