Provider Demographics
NPI:1104955699
Name:AHMAD, TARIQ (MD)
Entity type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208017
Mailing Address - Street 2:333 CEDAR ST.
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8017
Mailing Address - Country:US
Mailing Address - Phone:203-785-7191
Mailing Address - Fax:203-785-2917
Practice Address - Street 1:333 CEDAR ST.
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-8017
Practice Address - Country:US
Practice Address - Phone:203-785-7191
Practice Address - Fax:203-785-2917
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228737207R00000X
CT053951207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine