Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | XXXXX | OH |
NPI | 1588871297 |
---|---|
Provider Name | Nasra Mohamed Ahmed |
First Address | Beavercreek, OH 45431-6600 |
Second Address | Columbus, OH 43228-6491 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 05/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0066074 | (05) | OH |
H104090 | (02) | OH |