Provider Demographics
NPI:1215955000
Name:AHMAR, AYESHA R (MD)
Entity type:Individual
Prefix:
First Name:AYESHA
Middle Name:R
Last Name:AHMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 848370
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8370
Mailing Address - Country:US
Mailing Address - Phone:407-333-3360
Mailing Address - Fax:407-333-2920
Practice Address - Street 1:1349 S INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 1411
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746
Practice Address - Country:US
Practice Address - Phone:407-333-3360
Practice Address - Fax:407-333-2920
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME79324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
593745750OtherTAX ID
FL262674800Medicaid
H28365Medicare UPIN
FLK3273Medicare PIN