Provider Demographics
NPI:1588635395
Name:KARIM, AHAMED (MD)
Entity Type:Individual
Prefix:DR
First Name:AHAMED
Middle Name:
Last Name:KARIM
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:185-A DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071
Practice Address - Country:US
Practice Address - Phone:610-824-2121
Practice Address - Fax:610-824-2122
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010557792084N0400X
IN01055779A2084S0012X, 2085R0202X
MO1080112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN130025040OtherRR MEDICARE
MO204713507Medicaid
IN000000222008OtherANTHEM
IN7236013OtherAETNA REFERRAL NUMBER
IN129480500OtherDEPT OF LABOR
IN200349120AMedicaid
IN7236013OtherAETNA REFERRAL NUMBER
IN129480500OtherDEPT OF LABOR
MO327185236Medicare PIN
MO204713507Medicaid
MOP00433374Medicare PIN