Provider Demographics
NPI:1528061330
Name:AHMAR, WASIM (MD)
Entity type:Individual
Prefix:
First Name:WASIM
Middle Name:
Last Name:AHMAR
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 1:450 W STATE ROAD 434
Mailing Address - Street 2:STE 301
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5187
Mailing Address - Country:US
Mailing Address - Phone:407-767-8200
Mailing Address - Fax:407-339-1200
Practice Address - Street 1:450 W STATE ROAD 434
Practice Address - Street 2:STE 301
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5187
Practice Address - Country:US
Practice Address - Phone:407-767-8200
Practice Address - Fax:407-339-1200
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78066207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261225900Medicaid
FL261225900Medicaid
FL47021YMedicare PIN