MEDICARE: AYESHA R AHMAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME79324	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	593745750	OTHER	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215955000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYESHA R AHMAR MD

Provider Business Mailing Address
First Line	:	PO BOX 848370
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02284-8370
Country	:	US
Telephone Number	:	407-333-3360
Fax Number	:	407-333-2920

Provider Business Practice Location Address
First Line	:	1349 S INTERNATIONAL PKWY
Second Line	:	SUITE 1411
City	:	LAKE MARY
State	:	FL
Zip	:	32746
Country	:	US
Telephone Number	:	407-333-3360
Fax Number	:	407-333-2920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/19/2010

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Directions to “ AYESHA R AHMAR MD” Practice Location

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