Healthcare Provider Details

I. General information

NPI: 1033254115
Provider Name (Legal Business Name): KHALID AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 GODDARD PKWY
SALISBURY MD
21801-1126
US

IV. Provider business mailing address

23315 FITZGERALD RD
BOTHELL WA
98021-8908
US

V. Phone/Fax

Practice location:
  • Phone: 410-334-6961
  • Fax: 410-334-6960
Mailing address:
  • Phone: 410-294-4098
  • Fax: 425-354-3724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0062544
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0062544
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: