1417947516 NPI number — ABDUL RAZZAQUE AHMED MD

Table of content: ABDUL RAZZAQUE AHMED MD (NPI 1417947516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417947516 NPI number — ABDUL RAZZAQUE AHMED MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHMED
Provider First Name:
ABDUL
Provider Middle Name:
RAZZAQUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1417947516
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
697 CAMBRIDGE ST
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02135-2897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-562-1040
Provider Business Mailing Address Fax Number:
617-562-1047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
697 CAMBRIDGE ST
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02135-2897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-562-1040
Provider Business Practice Location Address Fax Number:
617-562-1047
Provider Enumeration Date:
10/28/2005

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: 207N00000X , with the licence number:  58320 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 26705 . This is a "FALLON HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 38404 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0300099 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 053820 . This is a "TUFTS SECURE HORIZONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: J08437 . This is a "BCBS MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0080243 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 401193 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 401193 . This is a "HARVARD PILGRIM HEALTH" identifier . This identifiers is of the category "OTHER".




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