Healthcare Provider Details

I. General information

NPI: 1558351411
Provider Name (Legal Business Name): AITEZAZ UDDIN AHMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 MONROE AVE
ROCHESTER NY
14618-2419
US

IV. Provider business mailing address

2210 MONROE AVE
ROCHESTER NY
14618-2419
US

V. Phone/Fax

Practice location:
  • Phone: 575-256-2030
  • Fax: 585-256-2037
Mailing address:
  • Phone: 575-256-2030
  • Fax: 585-256-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number216803
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: