Provider Demographics
NPI:1699856559
Name:AHMAD, MASOOD (MD)
Entity Type:Individual
Prefix:
First Name:MASOOD
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 1:6964 TYLERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-777-7097
Mailing Address - Fax:513-777-0841
Practice Address - Street 1:6964 TYLERSVILLE RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069
Practice Address - Country:US
Practice Address - Phone:513-777-7097
Practice Address - Fax:513-777-0841
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057646207RA0201X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0741175Medicaid
AH0678993Medicare ID - Type Unspecified
OH0741175Medicaid