Healthcare Provider Details

I. General information

NPI: 1376528141
Provider Name (Legal Business Name): SYEDA A AWAIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CAREW ST SUITE 230
SPRINGFIELD MA
01104-2301
US

IV. Provider business mailing address

299 CAREW ST SUITE 230
SPRINGFIELD MA
01104-2301
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-8129
  • Fax: 413-733-9441
Mailing address:
  • Phone: 508-595-0531
  • Fax: 508-829-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number79722
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierJ14911
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CROSS
# 2
Identifier3129993
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: