Provider Demographics
NPI:1548675663
Name:AHMED, BASHAR KHANDAKER (MD)
Entity type:Individual
Prefix:DR
First Name:BASHAR
Middle Name:KHANDAKER
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1221 FARMERS LN STE 500
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6712
Mailing Address - Country:US
Mailing Address - Phone:707-308-3105
Mailing Address - Fax:707-546-4062
Practice Address - Street 1:1221 FARMERS LN STE 500
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6712
Practice Address - Country:US
Practice Address - Phone:707-308-3105
Practice Address - Fax:707-546-4062
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ58125207LP2900X
CAA152947207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine