Healthcare Provider Details

I. General information

NPI: 1578241964
Provider Name (Legal Business Name): PRATYAKSH PRASHANTH VAISHNAV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT. OF MEDICINE MEDICAL SERVICE GROUP 750 E. ADAMS ST.
SYRACUSE NY
13210
US

IV. Provider business mailing address

DEPT. OF MEDICINE MEDICAL SERVICE GROUP 750 E. ADAMS ST.
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5774
  • Fax: 315-464-5378
Mailing address:
  • Phone: 315-464-5774
  • Fax: 315-464-5378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number346622
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number346622
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: