Provider Demographics
NPI:1134157811
Name:AHMED, FAWAD (MD)
Entity type:Individual
Prefix:
First Name:FAWAD
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 1:3885 OAKWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6257
Mailing Address - Country:US
Mailing Address - Phone:407-851-5600
Mailing Address - Fax:407-438-0507
Practice Address - Street 1:3885 OAKWATER CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6257
Practice Address - Country:US
Practice Address - Phone:407-851-5600
Practice Address - Fax:407-438-0507
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88757207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276772400Medicaid
FL53316OtherBC/BS
FL7275901OtherAETNA
FL2646797OtherUNITED HEALTHCARE
FLU7919ZMedicare PIN
FL7275901OtherAETNA
P00457581Medicare PIN