Healthcare Provider Details

I. General information

NPI: 1578983029
Provider Name (Legal Business Name): MARIAM J AHMED M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ESPLANADE AVE SUITE # 412
KENNER LA
70065-2489
US

IV. Provider business mailing address

200 W ESPLANADE AVE SUITE # 412
KENNER LA
70065-2489
US

V. Phone/Fax

Practice location:
  • Phone: 504-464-2940
  • Fax: 504-464-2941
Mailing address:
  • Phone: 504-464-2940
  • Fax: 504-464-2941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberS2208
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: