Healthcare Provider Details

I. General information

NPI: 1720243413
Provider Name (Legal Business Name): AZFAR AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 KIMBALL AVE
PENN YAN NY
14527-1816
US

IV. Provider business mailing address

601B W WASHINGTON ST
GENEVA NY
14456-2119
US

V. Phone/Fax

Practice location:
  • Phone: 315-536-2752
  • Fax: 315-536-4005
Mailing address:
  • Phone: 315-781-8448
  • Fax: 315-781-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number249588
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number249588
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number249588
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: