Izza Ahmed
Individual provider Active NPI General Practice Physician · Lynchburg, VA
NPI 1124861257 · NPPES record last updated Jun 17, 2024
Key facts
- NPI
- 1124861257
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 0116039719 (VA)
- Practice address
- 2323 Memorial Ave Ste 10
Lynchburg, VA 24501-2652 - Phone
- (434) 200-5200
- NPI assigned
- Jun 17, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241204004274 | VA | Order and Referring Only - Family Practice |
4880120591 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0116039719 | VA | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 0116039719 | VA | Yes |
Addresses
Primary practice location
2323 Memorial Ave Ste 10
Lynchburg, VA 24501-2652
Mailing address
2323 Memorial Ave Ste 10
Lynchburg, VA 24501-2652
Phone (434) 200-5200
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.