Healthcare Provider Details

I. General information

NPI: 1831432590
Provider Name (Legal Business Name): AHMAD MAHDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 BAY RIDGE PKWY
BROOKLYN NY
11209-2702
US

IV. Provider business mailing address

458 BAY RIDGE PKWY
BROOKLYN NY
11209-2702
US

V. Phone/Fax

Practice location:
  • Phone: 718-833-0741
  • Fax: 877-991-6654
Mailing address:
  • Phone: 718-833-0741
  • Fax: 877-991-6654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number274922
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD449941
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: