Provider Demographics
NPI:1922028604
Name:AHMED, MATEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATEEN
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 1:110 HARDIN LN
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3818
Mailing Address - Country:US
Mailing Address - Phone:606-678-0946
Mailing Address - Fax:606-678-0949
Practice Address - Street 1:110 HARDIN LANE
Practice Address - Street 2:SUITE10
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503
Practice Address - Country:US
Practice Address - Phone:606-678-0946
Practice Address - Fax:606-678-0949
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048613A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC306715Medicaid
SC01198756OtherAMERIGROUP
SC20077738OtherSELECT HEALTH
KY7100184950Medicaid
SC9358175OtherAETNA
KY7100184950Medicaid
SC9358175OtherAETNA