Basic Information
| Provider Information | |||||||||
| NPI: | 1588871297 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHMED | ||||||||
| FirstName: | NASRA | ||||||||
| MiddleName: | MOHAMED | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 MISSION POINT BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454316600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9379124441 | ||||||||
| FaxNumber: | 9374294236 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 CLIME RD | ||||||||
| Address2: | #110 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432286491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142721100 | ||||||||
| FaxNumber: | 6142721104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 10/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X | XXXXX | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0066074 | 05 | OH | MEDICAID |