Provider Demographics
NPI:1215093125
Name:AHMED, EDNAN (MD)
Entity type:Individual
Prefix:DR
First Name:EDNAN
Middle Name:
Last Name:AHMED
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 1:215 S HICKORY ST
Mailing Address - Street 2:STE 102
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4360
Mailing Address - Country:US
Mailing Address - Phone:617-962-3708
Mailing Address - Fax:
Practice Address - Street 1:215 S HICKORY ST
Practice Address - Street 2:STE 102
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4360
Practice Address - Country:US
Practice Address - Phone:760-743-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231585207W00000X
CAA107504207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0001485OtherMEDICARE
MAAA99156OtherHARVARD PILGRIM
MA2142724Medicaid
MAJ42430OtherBLUE CROSS BLUE SHIELD OF MASSACHUSETTS