MEDICARE: NOUSHIN SUMMIT AHMED O.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	152W00000X	Optometrist	TA2374	MD

General Provider Information

NPI Number	:	1922422732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOUSHIN SUMMIT AHMED O.D.

Provider Business Mailing Address
First Line	:	2023 PULASKI HWY
Second Line	:
City	:	HAVRE DE GRACE
State	:	MD
Zip	:	21078-2137
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 MAGOTHY BEACH RD STE 104
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-4467
Country	:	US
Telephone Number	:	410-437-6000
Fax Number	:	410-437-6001

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

Provider Enumeration Date	:	02/13/2014
Last Update Date	:	05/22/2023

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