Healthcare Provider Details

I. General information

NPI: 1578693917
Provider Name (Legal Business Name): AHMAD M. MEHDI M.D P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SYKES ST
GROTON NY
13073-1231
US

IV. Provider business mailing address

100 SYKES ST PO BOX 68
GROTON NY
13073-1231
US

V. Phone/Fax

Practice location:
  • Phone: 607-898-5827
  • Fax: 607-898-9726
Mailing address:
  • Phone: 607-898-5827
  • Fax: 607-898-9726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number215330-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number007106-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. AHAMD M. MEHDI
Title or Position: DR
Credential: M.D
Phone: 607-898-5827