Provider Demographics
NPI:1427037159
Name:MEHDI, AHMAD M (MD)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:M
Last Name:MEHDI
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:PO BOX 68
Mailing Address - Street 2:100 SYKES ST
Mailing Address - City:GROTON
Mailing Address - State:NY
Mailing Address - Zip Code:13073
Mailing Address - Country:US
Mailing Address - Phone:607-898-5827
Mailing Address - Fax:607-898-9726
Practice Address - Street 1:100 SYKES ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:NY
Practice Address - Zip Code:13073
Practice Address - Country:US
Practice Address - Phone:607-898-5827
Practice Address - Fax:607-898-9726
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2153301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCFP/2153302OtherCOMPENSATION CODE
NY01983962Medicaid
NY000024791OtherBCBS
NY01983962Medicaid