Healthcare Provider Details

I. General information

NPI: 1104748656
Provider Name (Legal Business Name): SIRAJ AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S CEDAR CREST BLVD
ALLENTOWN PA
18103-6202
US

IV. Provider business mailing address

2620 MOUNTAIN LN
ALLENTOWN PA
18103-7351
US

V. Phone/Fax

Practice location:
  • Phone: 570-309-1662
  • Fax:
Mailing address:
  • Phone: 570-309-1662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMT236894
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: