MEDICARE: MUTAHAR 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	208800000X	Urology Physician	25MA07065900	NJ

General Provider Information

NPI Number	:	1760451827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUTAHAR AHMED MD

Provider Business Mailing Address
First Line	:	1 DIAMOND HILL RD STE 101
Second Line	:
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-2104
Country	:	US
Telephone Number	:	908-273-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 W SPRING VALLEY AVE
Second Line	:	SUITE 101
City	:	MAYWOOD
State	:	NJ
Zip	:	07607-1445
Country	:	US
Telephone Number	:	201-487-8866
Fax Number	:	201-487-2610

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	03/04/2022

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