Provider Demographics
NPI:1417111063
Name:AHMAD, MUSSABER MUSHTAQ (DO)
Entity type:Individual
Prefix:
First Name:MUSSABER
Middle Name:MUSHTAQ
Last Name:AHMAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 S STATE ST.
Mailing Address - Street 2:MAIL CODE 3055
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-422-6050
Mailing Address - Fax:302-422-6685
Practice Address - Street 1:112 SUSSEX AVE STE 150
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1836
Practice Address - Country:US
Practice Address - Phone:302-422-6050
Practice Address - Fax:302-422-6685
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0012708207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA489842Medicare PIN
MD119591300Medicaid
211833Medicare Oscar/Certification