Healthcare Provider Details

I. General information

NPI: 1235162629
Provider Name (Legal Business Name): RIVER REGION CARDIOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 MITYLENE PARK LN
MONTGOMERY AL
36117-7302
US

IV. Provider business mailing address

185 MITYLENE PARK LN
MONTGOMERY AL
36117-7302
US

V. Phone/Fax

Practice location:
  • Phone: 334-387-0948
  • Fax: 334-387-0955
Mailing address:
  • Phone: 334-387-0948
  • Fax: 334-387-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number123456
License Number StateAL

VIII. Authorized Official

Name: DR. MOHAMMAD LUQMAN AHMED
Title or Position: PRESIDENT
Credential: M.D.
Phone: 334-387-0948