Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 3089 | VA |
Y | 2084N0400X | Neurologist | 010230245 | VA |
N | 2084N0400X | Neurologist | D0061334 | MD |
N | 2084V0102X | Vascular Neurology | 242 | VA |
NPI | 1326008384 |
---|---|
Provider Name | Ishtiaq Ahmad |
First Address | Reston, VA 20190-5896 |
Second Address | Reston, VA 20190-5896 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 29/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010358906 | (05) | VA |
404642100 | (05) | MD |
6432-0001 | CAREFIRST (01) | |
I05705 | (02) |