Healthcare Provider Details

I. General information

NPI: 1730178203
Provider Name (Legal Business Name): MEHMOOD RIAZ AHMAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 ROUTE 46 E
MOUNTAIN LAKES NJ
07046-1717
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 973-586-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMA28288
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: