Healthcare Provider Details

I. General information

NPI: 1356863377
Provider Name (Legal Business Name): NOAMAN AHMAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 N ACADIA RD STE 405
THIBODAUX LA
70301-4897
US

IV. Provider business mailing address

604 N ACADIA RD STE 405
THIBODAUX LA
70301-4897
US

V. Phone/Fax

Practice location:
  • Phone: 985-493-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number353724
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: