Provider Demographics
NPI:1801023254
Name:AHMED, MARWA A (MD)
Entity Type:Individual
Prefix:
First Name:MARWA
Middle Name:A
Last Name:AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 1ST AVE
Mailing Address - Street 2:SUITE 2105
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3109
Mailing Address - Country:US
Mailing Address - Phone:617-952-5254
Mailing Address - Fax:
Practice Address - Street 1:20 GUEST ST
Practice Address - Street 2:SUITE 150
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2040
Practice Address - Country:US
Practice Address - Phone:617-562-0585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
MA2678722081S0010X
CA1362342081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program