Healthcare Provider Details

I. General information

NPI: 1184071110
Provider Name (Legal Business Name): AHMAD RIDWANUR RAHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 CETRONIA RD STE 100N
ALLENTOWN PA
18104-9263
US

IV. Provider business mailing address

240 CETRONIA RD STE 100N
ALLENTOWN PA
18104-9263
US

V. Phone/Fax

Practice location:
  • Phone: 610-628-8010
  • Fax:
Mailing address:
  • Phone: 610-628-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD486093
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: