Healthcare Provider Details

I. General information

NPI: 1972246775
Provider Name (Legal Business Name): MEHRAB AHSAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

484 S SALINA ST APT 306
SYRACUSE NY
13202-4805
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-4259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number345525
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: