Healthcare Provider Details

I. General information

NPI: 1245663574
Provider Name (Legal Business Name): AHMED KHURSHID PASHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 CHARLES ST STE 300
ROCKFORD IL
61104-2200
US

IV. Provider business mailing address

33 MITCHELL AVE
BINGHAMTON NY
13903-1642
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-5888
  • Fax:
Mailing address:
  • Phone: 607-762-3281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number59961
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number310288
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR74175
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036-173567
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number59961
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: