Provider Demographics
NPI:1013238401
Name:ABAZID, AHMAD GHASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:GHASSAN
Last Name:ABAZID
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 1:4927 LAKE RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:888 S GREENVILLE AVE STE 304
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5044
Practice Address - Country:US
Practice Address - Phone:469-684-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-20
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284559207QG0300X
OK27230207Q00000X
TXN7769207QG0300X, 261QU0200X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care