Provider Demographics
NPI:1366567265
Name:AHMED, KHADIJA L (MD)
Entity type:Individual
Prefix:
First Name:KHADIJA
Middle Name:L
Last Name:AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KHADIJA
Other - Middle Name:L
Other - Last Name:FARIDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8006
Practice Address - Street 1:2100 EMMANUEL WAY STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-7218
Practice Address - Country:US
Practice Address - Phone:937-504-0120
Practice Address - Fax:937-521-1092
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-094335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3121615Medicaid
NY209478Medicaid
OHH082601Medicare PIN
OH3121615Medicaid