Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD23002 | OR |
Y | 111NI0900X | Internist | MD23002 | OR |
N | 207RG0300X | Geriatric Medicine | MD23002 | OR |
NPI | 1124046727 |
---|---|
Provider Name | Mahnaz Ahmad |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97220-9436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 10/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
218491 | (05) | OR |
P01010657 | RR MEDICARE (01) | OR |