Provider Demographics
NPI:1720016843
Name:AHMED, SAFIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:SAFIQUE
Middle Name:
Last Name:AHMED
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:PO BOX 58176
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25358-0176
Mailing Address - Country:US
Mailing Address - Phone:304-792-1132
Mailing Address - Fax:304-792-1133
Practice Address - Street 1:77 HOSPITAL DR STE 301
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3451
Practice Address - Country:US
Practice Address - Phone:304-792-1132
Practice Address - Fax:304-792-1133
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20171207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV64017122OtherKENTUCKY MEDICAID
WV1801195001Medicaid
WV9328351Medicare ID - Type Unspecified
WVG50756Medicare UPIN