=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356375513
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OMAR F. AHMAD, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 12/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3460 OLD WASHINGTON RD SUITE 302
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20602-3240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-893-3484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3460 OLD WASHINGTON RD SUITE 302
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20602-3240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-893-3484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.E.O.
-----------------------------------------------------
Name | DR. OMAR FAROOQ AHMAD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 301-893-3484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | D0061689
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------