Basic Information
Provider Information | |||||||||
NPI: | 1558439133 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AHMAD | ||||||||
FirstName: | ROMMAAN | ||||||||
MiddleName: | S | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8926 WOODYARD RD | ||||||||
Address2: | SUITE 701 | ||||||||
City: | CLINTON | ||||||||
State: | MD | ||||||||
PostalCode: | 207354220 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3018561682 | ||||||||
FaxNumber: | 3018560964 | ||||||||
Practice Location | |||||||||
Address1: | 8926 WOODYARD RD | ||||||||
Address2: | SUITE 701 | ||||||||
City: | CLINTON | ||||||||
State: | MD | ||||||||
PostalCode: | 207354220 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3018561682 | ||||||||
FaxNumber: | 3018560964 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/01/2006 | ||||||||
LastUpdateDate: | 01/30/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 5101015235 | MI | Y |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   | 208VP0000X | H72937 | MD | N |   | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
ID | Type | State | Issuer | Description | 1939812 | 01 |   | CIGNA | OTHER | 231834YZW | 01 |   | METRO MEDICARE | OTHER | 9339815 | 01 |   | AETNA PPO | OTHER | CI2264 | 01 |   | RAILROAD MEDICARE GROUP PTAN | OTHER | 8190869 | 01 |   | AETNA HMO | OTHER | 975577-01 | 01 |   | CAREFIRST MARYLAND | OTHER | P00992726 | 01 |   | RAILROAD MEDICARE INDIVIDUAL PTAN | OTHER | 11688989 | 01 |   | CAQH | OTHER | 975577-02 | 01 |   | CAREFIRST MARYLAND | OTHER | 46950049 | 01 |   | CAREFIRST NCA | OTHER |