Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0101250116 | VA |
N | 111NI0900X | Internist | 0101250116 | VA |
N | 207R00000X | Internist | 25MA07941400 | NJ |
N | 111NI0900X | Internist | 25MA07941400 | NJ |
N | 207RC0000X | Internist - Cardiovascular Disease | 0101250116 | VA |
Y | 207RI0011X | Interventional Cardiology | 0101250116 | VA |
N | 208D00000X | General Practice Physician | 25MA07941400 | NJ |
NPI | 1093796310 |
---|---|
Provider Name | Dr. Masood Ahmed |
First Address | Newport News, VA 23602-4404 |
Second Address | Newport News, VA 23606-4434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 10/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I40284 | (02) | NJ |