Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 20364 | OK |
N | 111NI0900X | Internist | 20364 | OK |
N | 207R00000X | Internist | 47207-020 | WI |
N | 111NI0900X | Internist | 47207-020 | WI |
Y | 207RG0300X | Geriatric Medicine | D85075 | MD |
NPI | 1134666019 |
---|---|
Provider Name | Dr. Shaista Urooj Ahmed |
First Address | Baltimore, MD 21236-4902 |
Second Address | Baltimore, MD 21224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2017 |
Last Update Date | 25/08/2018 |