Provider Demographics
NPI:1902367345
Name:MIRZA N. AHMAD, M.D., INC.
Entity Type:Organization
Organization Name:MIRZA N. AHMAD, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRZA
Authorized Official - Middle Name:N
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-497-0817
Mailing Address - Street 1:4782 MUNSON ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3630
Mailing Address - Country:US
Mailing Address - Phone:330-497-0817
Mailing Address - Fax:330-497-0819
Practice Address - Street 1:4782 MUNSON ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3630
Practice Address - Country:US
Practice Address - Phone:330-497-0817
Practice Address - Fax:330-497-0819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0255325Medicaid