Provider Demographics
NPI:1669172722
Name:CHAM, AHMED (RN, BSN,)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:CHAM
Suffix:
Gender:M
Credentials:RN, BSN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 ELISTON ST
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3909
Mailing Address - Country:US
Mailing Address - Phone:301-768-9155
Mailing Address - Fax:
Practice Address - Street 1:2817 ELISTON ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3909
Practice Address - Country:US
Practice Address - Phone:301-768-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206581163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice