Provider Demographics
NPI:1023093325
Name:AHMAD, IJAZ (MD)
Entity type:Individual
Prefix:MR
First Name:IJAZ
Middle Name:
Last Name:AHMAD
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 1:2828 FIRST AVE SUITE 202
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1236
Mailing Address - Country:US
Mailing Address - Phone:304-522-1299
Mailing Address - Fax:304-522-2954
Practice Address - Street 1:2828 FIRST AVE SUITE 202
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1236
Practice Address - Country:US
Practice Address - Phone:304-522-1299
Practice Address - Fax:304-522-2954
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV123982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0090974000Medicaid
OH0351159Medicaid
KY64694862Medicaid
WV0893861Medicare PIN
D91191Medicare UPIN
KY64694862Medicaid