Provider Demographics
NPI:1760665897
Name:HEFUNA, AHMED ESSAM (MD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:ESSAM
Last Name:HEFUNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:828 AIRPAX RD
Mailing Address - Street 2:BLDG B STE 300
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-6405
Mailing Address - Country:US
Mailing Address - Phone:410-228-3929
Mailing Address - Fax:410-228-3810
Practice Address - Street 1:828 AIRPAX RD
Practice Address - Street 2:BLDG B STE 300
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-6405
Practice Address - Country:US
Practice Address - Phone:410-228-3929
Practice Address - Fax:410-228-3810
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD665762084P0800X
MDD00665762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD774800100Medicaid
MD774800100Medicaid