Healthcare Provider Details

I. General information

NPI: 1952806242
Provider Name (Legal Business Name): HEITHAM WADY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W TAFT RD STE 1C
LIVERPOOL NY
13088-3808
US

IV. Provider business mailing address

5100 W TAFT RD STE 1C
LIVERPOOL NY
13088-3808
US

V. Phone/Fax

Practice location:
  • Phone: 315-634-3399
  • Fax: 315-634-3481
Mailing address:
  • Phone: 315-634-3399
  • Fax: 315-634-3481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number329224
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: