Provider Demographics
NPI:1699422915
Name:AHMED, MOHAMED OMAR
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:OMAR
Last Name:AHMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23222 61ST AVE S APT GG201
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4864
Mailing Address - Country:US
Mailing Address - Phone:207-344-9589
Mailing Address - Fax:
Practice Address - Street 1:23222 61ST AVE S APT GG201
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4864
Practice Address - Country:US
Practice Address - Phone:207-344-9589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver