Healthcare Provider Details

I. General information

NPI: 1720016751
Provider Name (Legal Business Name): ABDUL KADER SOUID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

251 SALINA MEADOWS PKWY SUITE 100
SYRACUSE NY
13212-4584
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5294
  • Fax:
Mailing address:
  • Phone: 315-464-2096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number174728
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: