Provider Demographics
NPI:1366517997
Name:SPECIALIST FAMILY MEDICINE
Entity type:Organization
Organization Name:SPECIALIST FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YASMEEN
Authorized Official - Middle Name:GHIAS
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-744-8111
Mailing Address - Street 1:7001 JOHNNYCAKE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2418
Mailing Address - Country:US
Mailing Address - Phone:410-744-8111
Mailing Address - Fax:410-744-8110
Practice Address - Street 1:7001 JOHNNYCAKE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2418
Practice Address - Country:US
Practice Address - Phone:410-744-8111
Practice Address - Fax:410-744-8110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty