Basic Information
Provider Information | |||||||||
NPI: | 1316244718 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AHMAD | ||||||||
FirstName: | ASAD | ||||||||
MiddleName: | HAYAT | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2771 RYEWOOD AVE | ||||||||
Address2: | APT E | ||||||||
City: | COPLEY | ||||||||
State: | OH | ||||||||
PostalCode: | 443212805 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3305766101 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 11100 EUCLID AVE | ||||||||
Address2: |   | ||||||||
City: | CLEVELAND | ||||||||
State: | OH | ||||||||
PostalCode: | 441061716 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2168441000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/21/2011 | ||||||||
LastUpdateDate: | 02/21/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 35.096675 | OH | Y |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZB0001X | 35.096675 | OH | N |   | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZP0104X | 35.096675 | OH | N |   | Allopathic & Osteopathic Physicians | Pathology | Chemical Pathology | 207ZP0105X | 35.096675 | OH | N |   | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | 207ZC0500X | 35.096675 | OH | N |   | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZH0000X | 35.096675 | OH | N |   | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZI0100X | 35.096675 | OH | N |   | Allopathic & Osteopathic Physicians | Pathology | Immunopathology | 207ZM0300X | 35.096675 | OH | N |   | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | 207ZP0007X | 35.096675 | OH | N |   | Allopathic & Osteopathic Physicians | Pathology | Molecular Genetic Pathology |
ID Information
ID | Type | State | Issuer | Description | 1026663100001 | 05 | PA |   | MEDICAID | P00949816 | 01 | OH | MEDICARE RAILROAD | OTHER | 3148829 | 05 | OH |   | MEDICAID |