Provider Demographics
NPI:1659390045
Name:AHMAD, NISAR (MD)
Entity Type:Individual
Prefix:
First Name:NISAR
Middle Name:
Last Name:AHMAD
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 1:1719 TREASURE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8912
Mailing Address - Country:US
Mailing Address - Phone:956-364-2131
Mailing Address - Fax:956-364-2141
Practice Address - Street 1:1719 TREASURE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8912
Practice Address - Country:US
Practice Address - Phone:956-364-2131
Practice Address - Fax:956-364-2141
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4887207RX0202X, 207RH0000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419512400Medicaid
MD962456-01 & 02OtherBLUE CROSS/BLUE SHIELD
MDS062-0381OtherBLUE CROSS/BLUE SHIELD - REGIONAL
TX374773501Medicaid
TX8HE963OtherBLUE CROSS/BLUE SHIELD OF TEXAS
OH0070245Medicaid
MD962456-01 & 02OtherBLUE CROSS/BLUE SHIELD
MD176533Y1PMedicare PIN
MDS062-0381OtherBLUE CROSS/BLUE SHIELD - REGIONAL
I72305Medicare UPIN