Provider Demographics
NPI:1720248685
Name:AHMED, SUMERA (MD)
Entity Type:Individual
Prefix:
First Name:SUMERA
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PROSPECT AVE
Mailing Address - Street 2:HOSPITAL INTERNISTS
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1807
Mailing Address - Country:US
Mailing Address - Phone:315-448-5704
Mailing Address - Fax:315-423-6853
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:HOSPITAL INTERNISTS
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-5704
Practice Address - Fax:315-423-6853
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257028208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03271267Medicaid
NYP00924810OtherRAILROAD MEDICARE PTAN
NYJ400043489Medicare PIN