Healthcare Provider Details

I. General information

NPI: 1952063190
Provider Name (Legal Business Name): ABDELRAHMAN MAHMOUD FAWZI ELSAYED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 09/06/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF PEDIATRICS, DIVISION OF INFECTIOUS DISEAS 750 E. ADAMS STREET, 5TH FLOOR
SYRACUSE NY
13210
US

IV. Provider business mailing address

DEPARTMENT OF PEDIATRICS, DIVISION OF INFECTIOUS DISEAS 750 E. ADAMS STREET, 5TH FLOOR
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 567-322-5681
  • Fax:
Mailing address:
  • Phone: 567-322-5681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number332649
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number332649
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: