Provider Demographics
NPI:1174698740
Name:AIJAZ AHMED, M.D.
Entity type:Organization
Organization Name:AIJAZ AHMED, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AIJAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-653-4666
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-0596
Mailing Address - Country:US
Mailing Address - Phone:937-653-4666
Mailing Address - Fax:
Practice Address - Street 1:900 SCIOTO ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-2251
Practice Address - Country:US
Practice Address - Phone:937-653-4666
Practice Address - Fax:937-653-3469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060127207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0797160Medicaid
OH0669532Medicare PIN