Provider Demographics
NPI:1811942501
Name:AHILAN, PARA (MD)
Entity type:Individual
Prefix:MR
First Name:PARA
Middle Name:
Last Name:AHILAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PARAMANTHAN
Other - Middle Name:
Other - Last Name:AHILAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11 RALPH PL
Mailing Address - Street 2:SUITE 109
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4419
Mailing Address - Country:US
Mailing Address - Phone:718-981-3674
Mailing Address - Fax:718-981-5003
Practice Address - Street 1:11 RALPH PL
Practice Address - Street 2:SUITE 109
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4419
Practice Address - Country:US
Practice Address - Phone:718-981-3674
Practice Address - Fax:718-981-5003
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2128091207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01921668Medicaid
NY01921668Medicaid
55N421Medicare ID - Type Unspecified