Provider Demographics
NPI:1588637623
Name:NASRATY, AHMAD NAWEED (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:NAWEED
Last Name:NASRATY
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 1:5001 SPRING FARM RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9654
Mailing Address - Country:US
Mailing Address - Phone:502-584-4479
Mailing Address - Fax:
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2877
Practice Address - Country:US
Practice Address - Phone:812-948-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64289101Medicaid
KY1106140OtherPASSPORT
KY2434853000OtherPASSPORT ADVANTAGE
KY000000066562OtherANTHEM
IN200270790Medicaid
KY0604901Medicare PIN
KY000000066562OtherANTHEM