Basic Information
Provider Information | |||||||||
NPI: | 1801276472 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AHMED | ||||||||
FirstName: | HEIDI | ||||||||
MiddleName: | SHAIFQUN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 85 E CONCORD ST STE 7720 | ||||||||
Address2: |   | ||||||||
City: | BOSTON | ||||||||
State: | MA | ||||||||
PostalCode: | 021182335 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6176386525 | ||||||||
FaxNumber: | 6176386529 | ||||||||
Practice Location | |||||||||
Address1: | 20 RESEARCH PL STE 220 | ||||||||
Address2: |   | ||||||||
City: | NORTH CHELMSFORD | ||||||||
State: | MA | ||||||||
PostalCode: | 018632455 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9784596737 | ||||||||
FaxNumber: | 8558181869 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/09/2015 | ||||||||
LastUpdateDate: | 03/16/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/16/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | R-10327 | IA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RG0100X | 275290 | MA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.