Basic Information
| Provider Information | |||||||||
| NPI: | 1033142138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHSANUDDIN | ||||||||
| FirstName: | ASHFAQ | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 TUNNEL RD | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288052576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282987911 | ||||||||
| FaxNumber: | 8282995885 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 TUNNEL ROAD | ||||||||
| Address2: | CHARLES GEORGE VAMC- ASHEVILLE | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288051334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282992515 | ||||||||
| FaxNumber: | 8282995885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 09/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 20312 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2008-00231 | NC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1801503000 | 05 | WV | MEDICAID | 317844 | 01 | WV | ANTHEM BCBS | OTHER | 513111001 | 01 | WV | CIGNA | OTHER | 010070244 | 01 | WV | FIRST HEALTH | OTHER | 042 | 01 | WV | MTST BCBS | OTHER | 110215608 | 01 | WV | RAILROAD MEDICARE | OTHER | 134443 | 01 | WV | SOUTHERN HEALTH | OTHER | 293968 | 01 | WV | MAMSI | OTHER | 7706176 | 01 | WV | AETNA | OTHER |