Provider Demographics
NPI:1043475155
Name:AHMED, TANAM (MD)
Entity type:Individual
Prefix:
First Name:TANAM
Middle Name:
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 1:120 CYPRESS EDGE DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-8453
Mailing Address - Country:US
Mailing Address - Phone:386-586-4390
Mailing Address - Fax:386-586-4392
Practice Address - Street 1:120 CYPRESS EDGE DR
Practice Address - Street 2:SUITE 207
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8453
Practice Address - Country:US
Practice Address - Phone:386-586-4390
Practice Address - Fax:386-586-4392
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT193279390200000X
FLME109737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program