Healthcare Provider Details

I. General information

NPI: 1245525765
Provider Name (Legal Business Name): ISTEAQ AHMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N MAIN ST
LONDON OH
43140-1115
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 740-845-7000
  • Fax: 740-845-7701
Mailing address:
  • Phone: 740-845-7000
  • Fax: 740-845-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.124309
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number35.124309
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: