Provider Demographics
NPI:1851601488
Name:RAHMAN, AMBAR (MD)
Entity type:Individual
Prefix:
First Name:AMBAR
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1656 E NIGHTHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-9418
Mailing Address - Country:US
Mailing Address - Phone:520-381-6460
Mailing Address - Fax:520-381-6068
Practice Address - Street 1:1828 E FLORENCE BLVD
Practice Address - Street 2:138
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4783
Practice Address - Country:US
Practice Address - Phone:520-381-6460
Practice Address - Fax:520-381-6068
Is Sole Proprietor?:No
Enumeration Date:2010-10-17
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ45829207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist