Basic Information
Provider Information | |||||||||
NPI: | 1154634798 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AHMED | ||||||||
FirstName: | NAWAZ | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1105 TALL GRASS CIR | ||||||||
Address2: | 308 | ||||||||
City: | STOW | ||||||||
State: | OH | ||||||||
PostalCode: | 442246926 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: |   | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 155 5TH ST NE | ||||||||
Address2: |   | ||||||||
City: | BARBERTON | ||||||||
State: | OH | ||||||||
PostalCode: | 442033332 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3306153000 | ||||||||
FaxNumber: | 3306153030 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/25/2010 | ||||||||
LastUpdateDate: | 05/18/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 35.121926 | OH | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207Q00000X | 57.017641 | OH | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.