Provider Demographics
NPI:1093687402
Name:ULLAH, FAHIM RAHMAT
Entity type:Individual
Prefix:
First Name:FAHIM
Middle Name:RAHMAT
Last Name:ULLAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WINTERS LN
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2833
Mailing Address - Country:US
Mailing Address - Phone:443-600-3102
Mailing Address - Fax:
Practice Address - Street 1:28652 STATE HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:NY
Practice Address - Zip Code:12167-1712
Practice Address - Country:US
Practice Address - Phone:516-862-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-P138174-01207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine