Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | OS021427 | PA |
NPI | 1043707839 |
---|---|
Provider Name | Jawad Ahsan |
First Address | Utica, NY 13501-5930 |
Second Address | Utica, NY 13501-4308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2018 |
Last Update Date | 28/11/2021 |