Healthcare Provider Details

I. General information

NPI: 1407877202
Provider Name (Legal Business Name): ANIS AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 DELAWARE AVE SUITE 105
MILLSBORO DE
19966-1718
US

IV. Provider business mailing address

505 W MARKET ST STE 110
GEORGETOWN DE
19947-2344
US

V. Phone/Fax

Practice location:
  • Phone: 302-934-1861
  • Fax: 302-934-7318
Mailing address:
  • Phone: 302-854-0626
  • Fax: 302-752-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0058183
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC1 0005262
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC1-0005262
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: