Healthcare Provider Details

I. General information

NPI: 1073750840
Provider Name (Legal Business Name): TANVEER AHMED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 HOLLENBECK AVE
GREAT BARRINGTON MA
01230-1012
US

IV. Provider business mailing address

121 HOLLENBECK AVE
GREAT BARRINGTON MA
01230-1012
US

V. Phone/Fax

Practice location:
  • Phone: 646-678-2458
  • Fax: 413-645-1022
Mailing address:
  • Phone: 646-678-2458
  • Fax: 413-645-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number235002
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number274898
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: