Healthcare Provider Details

I. General information

NPI: 1609112457
Provider Name (Legal Business Name): AHMED FARGHAL AHMED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 E PULASKI HWY STE 1B
ELKTON MD
21921-6057
US

IV. Provider business mailing address

249 BARRETT RUN PL
NEWARK DE
19702-2971
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-0590
  • Fax:
Mailing address:
  • Phone: 410-398-0590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS03725
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: