Provider Demographics
NPI:1710940291
Name:AHMED, TARIQ (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 136TH PL NE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2331
Mailing Address - Country:US
Mailing Address - Phone:425-957-4484
Mailing Address - Fax:
Practice Address - Street 1:1805 136TH PL NE
Practice Address - Street 2:SUITE103
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2331
Practice Address - Country:US
Practice Address - Phone:425-957-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA309672083P0901X
WAMD00030967207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
53553Medicare UPIN
WAAB04558Medicare ID - Type Unspecified