Healthcare Provider Details

I. General information

NPI: 1437303641
Provider Name (Legal Business Name): MASOOD AHMAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6964 TYLERSVILLE RD
WEST CHESTER OH
45069-1511
US

IV. Provider business mailing address

6964 TYLERSVILLE RD
WEST CHESTER OH
45069-1511
US

V. Phone/Fax

Practice location:
  • Phone: 513-777-7097
  • Fax: 513-777-0841
Mailing address:
  • Phone: 513-777-7097
  • Fax: 513-777-0841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number35057646A
License Number StateOH

VIII. Authorized Official

Name: MASOOD AHMAD
Title or Position: OWNER
Credential: M.D.
Phone: 513-777-7097