Provider Demographics
NPI:1992774954
Name:AHMED, SURAIYA JABEEN (MD)
Entity type:Individual
Prefix:
First Name:SURAIYA
Middle Name:JABEEN
Last Name:AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 JEFFERSON AVE
Mailing Address - Street 2:MERCY CREDENTIALING OFFICE
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:OH
Practice Address - Zip Code:43469
Practice Address - Country:US
Practice Address - Phone:419-849-2871
Practice Address - Fax:419-849-3865
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0964363Medicaid
F76880Medicare UPIN
OHH298540Medicare PIN
OH0964363Medicaid