Provider Demographics
NPI:1255300422
Name:SHAHZAD, AHMED (MD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:SHAHZAD
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 1:2821 ISLAND AVE
Mailing Address - Street 2:SUITE 131
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-2300
Mailing Address - Country:US
Mailing Address - Phone:215-863-6171
Mailing Address - Fax:215-863-2364
Practice Address - Street 1:2821 ISLAND AVE
Practice Address - Street 2:SUITE 131
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-2300
Practice Address - Country:US
Practice Address - Phone:215-863-6171
Practice Address - Fax:215-863-2364
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055409L207RN0300X
NJ25MA07482000207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022738410001Medicaid
G87591Medicare UPIN
094763NIEMedicare ID - Type Unspecified