Provider Demographics
NPI:1184960098
Name:AKHMEDOV, AZIM
Entity type:Individual
Prefix:
First Name:AZIM
Middle Name:
Last Name:AKHMEDOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 FRANKS RD STE 5
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-4216
Mailing Address - Country:US
Mailing Address - Phone:215-825-5171
Mailing Address - Fax:215-825-5057
Practice Address - Street 1:3021 FRANKS RD STE 5
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-4216
Practice Address - Country:US
Practice Address - Phone:215-825-5171
Practice Address - Fax:215-825-5057
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver