Healthcare Provider Details

I. General information

NPI: 1154900470
Provider Name (Legal Business Name): MAHWISH IQBAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 IRVING AVE STE 200
SYRACUSE NY
13210-1668
US

IV. Provider business mailing address

1001 W FAYETTE ST STE 400
SYRACUSE NY
13204-2866
US

V. Phone/Fax

Practice location:
  • Phone: 315-479-5070
  • Fax:
Mailing address:
  • Phone: 315-937-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number331553
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: