1417788183 NPI number — ADNAN AHMAD PHYSICIAN ASSISTANT

Table of content: ADNAN AHMAD PHYSICIAN ASSISTANT (NPI 1417788183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417788183 NPI number — ADNAN AHMAD PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHMAD
Provider First Name:
ADNAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
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:
1417788183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
875 OAK ST SE STE C3010
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97301-3975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-399-7520
Provider Business Mailing Address Fax Number:
503-362-7344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4747 SKYLINE RD S STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97306-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-399-7520
Provider Business Practice Location Address Fax Number:
503-362-7344
Provider Enumeration Date:
08/13/2024

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: 363A00000X , with the licence number:  PA221244 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com