Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 0101049338 | VA |
NPI | 1003844911 |
---|---|
Provider Name | Mobashar Ahmad |
First Address | Herndon, VA 20170-5529 |
Second Address | Herndon, VA 20170-5529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
386123 | ANTHEM BC/BS (01) | VA |
5966669 | AETNA PPO (01) | VA |
G36359 | (02) | VA |
G82400001 | CAREFIRST BC/BS (01) | VA |