Healthcare Provider Details

I. General information

NPI: 1033869466
Provider Name (Legal Business Name): AMBIA AHMED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HIGH ST STE 302
LEWISTON ME
04240-7690
US

IV. Provider business mailing address

12 HIGH ST STE 302
LEWISTON ME
04240-7690
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-5730
  • Fax:
Mailing address:
  • Phone: 207-795-5730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD29639
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: