Healthcare Provider Details

I. General information

NPI: 1417419441
Provider Name (Legal Business Name): SYED TALHA QASMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE STE B6169A
ATLANTA GA
30322-3800
US

IV. Provider business mailing address

2100 W CENTRAL AVE
TOLEDO OH
43606-3800
US

V. Phone/Fax

Practice location:
  • Phone: 606-261-9868
  • Fax:
Mailing address:
  • Phone: 567-420-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301507152
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberPENDING
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: