Provider Demographics
NPI:1861473027
Name:ALTAF AHMED MD PA
Entity Type:Organization
Organization Name:ALTAF AHMED MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALTAF
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-400-0133
Mailing Address - Street 1:PO BOX 15009
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-5009
Mailing Address - Country:US
Mailing Address - Phone:505-400-0133
Mailing Address - Fax:575-233-6323
Practice Address - Street 1:4441 E LOHMAN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8267
Practice Address - Country:US
Practice Address - Phone:505-400-0133
Practice Address - Fax:575-233-6323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM009E41OtherBC/BS OF NM
NM14529041Medicaid
NM14529041Medicaid
NM400521138Medicare PIN