Provider Demographics
NPI:1134275340
Name:AHMED, ISHAQ (PAC)
Entity type:Individual
Prefix:
First Name:ISHAQ
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5018
Mailing Address - Country:US
Mailing Address - Phone:410-620-2070
Mailing Address - Fax:
Practice Address - Street 1:39 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5018
Practice Address - Country:US
Practice Address - Phone:410-620-2070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002245363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0002245OtherSTATE LICENSE