Basic Information
| Provider Information | |||||||||
| NPI: | 1093734667 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHMAD | ||||||||
| FirstName: | FUAD | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 INDEPENDENCE PT STE 212 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976247 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 701 GROVE RD FL 5 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296054210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644554411 | ||||||||
| FaxNumber: | 8644554480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 11/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 200000170 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 42038 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 200000170 | NC | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 01060888A | IN | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 17894 | SC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 178943 | 05 | SC | MEDICAID | SC53555019 | 01 | SC | MEDICARE PIN | OTHER | SC53559068 | 01 | SC | MEDICARE PIN | OTHER | 200531100 | 05 | IN | MEDICAID | 000000373463 | 01 | IN | BCBS - MARY STREET | OTHER | 000000386251 | 01 | IN | BCBS - GATEWAY | OTHER | 1093734667 | 05 | NC | MEDICAID | 000000637777 | 01 | KY | ANTHEM # WITH CHS, INC. | OTHER | 64108798 | 05 | KY | MEDICAID | 890638F | 05 | NC | MEDICAID | P00251302 | 01 | IN | RR MEDICARE PIN | OTHER |