Basic Information
Provider Information | |||||||||
NPI: | 1588783286 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AHMED | ||||||||
FirstName: | KHALEEL | ||||||||
MiddleName: | MOHAMMED | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | AHMED | ||||||||
OtherFirstName: | MOHAMMED | ||||||||
OtherMiddleName: | KHALEEL | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 900 CATON AVE | ||||||||
Address2: |   | ||||||||
City: | BALTIMORE | ||||||||
State: | MD | ||||||||
PostalCode: | 212295201 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6672343120 | ||||||||
FaxNumber: | 6672343525 | ||||||||
Practice Location | |||||||||
Address1: | 900 CATON AVE | ||||||||
Address2: |   | ||||||||
City: | BALTIMORE | ||||||||
State: | MD | ||||||||
PostalCode: | 212295201 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6672343120 | ||||||||
FaxNumber: | 6672343525 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/27/2007 | ||||||||
LastUpdateDate: | 04/25/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D67539 | MD | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RS0012X | D67539 | MD | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
No ID Information.