MEDICARE: DR. SAFIQUE AHMED M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	20171	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720016843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAFIQUE AHMED M.D.

Provider Business Mailing Address
First Line	:	PO BOX 58176
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25358-0176
Country	:	US
Telephone Number	:	304-792-1132
Fax Number	:	304-792-1133

Provider Business Practice Location Address
First Line	:	77 HOSPITAL DR STE 301
Second Line	:
City	:	LOGAN
State	:	WV
Zip	:	25601-3451
Country	:	US
Telephone Number	:	304-792-1132
Fax Number	:	304-792-1133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	01/30/2024

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