Provider Demographics
NPI:1063423408
Name:AL-MALT, AHMED M (MD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:M
Last Name:AL-MALT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:615 E PRINCETON ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1456
Mailing Address - Country:US
Mailing Address - Phone:407-897-3737
Mailing Address - Fax:407-897-3711
Practice Address - Street 1:615 E PRINCETON ST
Practice Address - Street 2:SUITE 240
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1456
Practice Address - Country:US
Practice Address - Phone:407-897-3737
Practice Address - Fax:407-897-3711
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME74032207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42268OtherBLUE CROSS/SHIELD
FL253286700Medicaid
42268YMedicare PIN
FL42268OtherBLUE CROSS/SHIELD