Provider Demographics
NPI:1538349071
Name:JAMIL AHMED, MD
Entity type:Organization
Organization Name:JAMIL AHMED, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-624-4654
Mailing Address - Street 1:527 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9007
Mailing Address - Country:US
Mailing Address - Phone:304-933-3816
Mailing Address - Fax:304-933-3819
Practice Address - Street 1:527 MEDICAL PARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9007
Practice Address - Country:US
Practice Address - Phone:304-933-3816
Practice Address - Fax:304-933-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21160207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVH83725Medicare UPIN
WVSP04931Medicare PIN