Provider Demographics
NPI:1396925509
Name:SHARIQ AHMAD, M.D. PA
Entity type:Organization
Organization Name:SHARIQ AHMAD, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IM/NEPHROLOGY SPECIALISTS
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:409-813-1677
Mailing Address - Street 1:810 HOSPITAL DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4600
Mailing Address - Country:US
Mailing Address - Phone:409-347-8372
Mailing Address - Fax:409-347-8363
Practice Address - Street 1:810 HOSPITAL DR
Practice Address - Street 2:SUITE 170
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4600
Practice Address - Country:US
Practice Address - Phone:409-347-8372
Practice Address - Fax:409-347-8363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0998174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG56498Medicare UPIN