Healthcare Provider Details

I. General information

NPI: 1588009849
Provider Name (Legal Business Name): SIMRIT SINGH WALIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2342
US

IV. Provider business mailing address

750 E ADAMS ST
SYRACUSE NY
13210-2342
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5240
  • Fax: 315-464-3751
Mailing address:
  • Phone: 315-464-5240
  • Fax: 315-464-3751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number0101260391
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: