Basic Information
Provider Information
NPI: 1326562299
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AHMED
FirstName: YASIR
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 33 LEWIS RD
Address2:  
City: BINGHAMTON
State: NY
PostalCode: 139051048
CountryCode: US
TelephoneNumber: 6077298156
FaxNumber:  
Practice Location
Address1: 4417 VESTAL PKWY E
Address2:  
City: VESTAL
State: NY
PostalCode: 138503556
CountryCode: US
TelephoneNumber: 6077707365
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/01/2017
LastUpdateDate: 08/12/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/12/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207R00000X305810NYY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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