Provider Demographics
NPI:1932182318
Name:AHMAD, SHIRIN (MD)
Entity Type:Individual
Prefix:
First Name:SHIRIN
Middle Name:
Last Name:AHMAD
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 1:1743 CREEKSIDE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3541
Mailing Address - Country:US
Mailing Address - Phone:916-983-2307
Mailing Address - Fax:916-983-8528
Practice Address - Street 1:1743 CREEKSIDE DR STE 130
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3541
Practice Address - Country:US
Practice Address - Phone:916-983-2307
Practice Address - Fax:916-983-8528
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89557207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL035958001OtherDMERC
CAI14177Medicare UPIN
CA00A895570Medicare ID - Type Unspecified