Provider Demographics
NPI:1649775610
Name:ASMA S. AHMAD, MD, LLC
Entity Type:Organization
Organization Name:ASMA S. AHMAD, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:034-128-3185
Mailing Address - Street 1:4160 SW CHARMING WAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-2025
Mailing Address - Country:US
Mailing Address - Phone:503-539-5537
Mailing Address - Fax:
Practice Address - Street 1:4160 SW CHARMING WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-2025
Practice Address - Country:US
Practice Address - Phone:503-539-5537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24699207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
13676466500OtherTYPE 1 (PERSONAL) NPI
ORMD24699OtherMEDICAL LICENSE
ORMD24699OtherMEDICAL LICENSE