Basic Information
| Provider Information | |||||||||
| NPI: | 1376079145 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHATILA | ||||||||
| FirstName: | AHMED | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 S GREENE ST # N3W156 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103285089 | ||||||||
| FaxNumber: | 4103288318 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 S GREENE ST # N3W156 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103285089 | ||||||||
| FaxNumber: | 4103288318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2017 | ||||||||
| LastUpdateDate: | 06/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | BP10010060864 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | BP10010060864 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.