Healthcare Provider Details

I. General information

NPI: 1710624630
Provider Name (Legal Business Name): KIRILL ZAGORODNEV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 08/11/2025
Certification Date: 01/30/2023
Deactivation Date: 01/13/2023
Reactivation Date: 01/30/2023

III. Provider practice location address

750 E. ADAMS ST
SYRACUSE NY
13210
US

IV. Provider business mailing address

750 E. ADAMS ST
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5910
  • Fax: 315-464-1937
Mailing address:
  • Phone: 315-464-5910
  • Fax: 315-464-1937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number337956
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: