Provider Demographics
NPI:1649336264
Name:AHMAD, MIR SHARIF (MD)
Entity type:Individual
Prefix:MR
First Name:MIR
Middle Name:SHARIF
Last Name:AHMAD
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 1:1950 ROUTE 27 SUITE F
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902
Mailing Address - Country:US
Mailing Address - Phone:732-422-8440
Mailing Address - Fax:732-422-8404
Practice Address - Street 1:1950 ROUTE 27 SUITE F
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902
Practice Address - Country:US
Practice Address - Phone:732-422-8440
Practice Address - Fax:732-422-8404
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62819207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7473605Medicaid
NJ003706Medicare ID - Type Unspecified
NJ7473605Medicaid