MEDICARE: GHAZANFAR AHMED 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	35087345	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000489143	OTHER	OH	ANTHEM BLUE SHIELD ELO LO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000489146	OTHER	OH	ANTHEM BLUE SHIELD LISBON

General Provider Information

NPI Number	:	1427069715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GHAZANFAR AHMED MD

Provider Business Mailing Address
First Line	:	7880 LINCOLE PL
Second Line	:
City	:	LISBON
State	:	OH
Zip	:	44432-8322
Country	:	US
Telephone Number	:	330-424-7221
Fax Number	:	330-424-3731

Provider Business Practice Location Address
First Line	:	16687 SAINT CLAIR AVE
Second Line	:	SUITE 203
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-9401
Country	:	US
Telephone Number	:	330-386-7777
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/13/2007

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Directions to “ GHAZANFAR AHMED MD” Practice Location

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