1922028604 NPI number — DR. MATEEN AHMED M.D

Table of content: DR. MATEEN AHMED M.D (NPI 1922028604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922028604 NPI number — DR. MATEEN AHMED M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHMED
Provider First Name:
MATEEN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922028604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 HARDIN LN
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42503-3818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-678-0946
Provider Business Mailing Address Fax Number:
606-678-0949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 HARDIN LANE
Provider Second Line Business Practice Location Address:
SUITE10
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-678-0946
Provider Business Practice Location Address Fax Number:
606-678-0949
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  01048613A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 306715 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01198756 . This is a "AMERIGROUP" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 20077738 . This is a "SELECT HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 7100184950 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9358175 . This is a "AETNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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