Provider Demographics
NPI:1265710693
Name:SHAMSEDEEN, AHAMED RAZVEEN (MD)
Entity type:Individual
Prefix:DR
First Name:AHAMED
Middle Name:RAZVEEN
Last Name:SHAMSEDEEN
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 1:111 W END RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18706-5448
Mailing Address - Country:US
Mailing Address - Phone:201-888-7295
Mailing Address - Fax:
Practice Address - Street 1:111 W END RD
Practice Address - Street 2:
Practice Address - City:HANOVER TWP
Practice Address - State:PA
Practice Address - Zip Code:18706-5448
Practice Address - Country:US
Practice Address - Phone:201-888-7295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD455218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY390200000XMedicaid