Healthcare Provider Details

I. General information

NPI: 1518596261
Provider Name (Legal Business Name): AHAD MUSSARAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8334 ACADEMY RD
ELLICOTT CITY MD
21043-6683
US

IV. Provider business mailing address

8334 ACADEMY RD
ELLICOTT CITY MD
21043-6683
US

V. Phone/Fax

Practice location:
  • Phone: 985-351-3926
  • Fax:
Mailing address:
  • Phone: 985-351-3926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number30138
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: