Healthcare Provider Details

I. General information

NPI: 1891932596
Provider Name (Legal Business Name): MARC RYAN IQBAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 09/06/2025
Certification Date: 09/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5606 BEAR RD
SYRACUSE NY
13212-1648
US

IV. Provider business mailing address

5606 BEAR RD
SYRACUSE NY
13212-1648
US

V. Phone/Fax

Practice location:
  • Phone: 315-414-6332
  • Fax: 315-314-6920
Mailing address:
  • Phone: 315-414-6332
  • Fax: 315-314-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD29180
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number265041
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number265041
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD29180
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: