Healthcare Provider Details

I. General information

NPI: 1699462507
Provider Name (Legal Business Name): RAZDUM UDDIN AHMED DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 S BAY RD
SYRACUSE NY
13212-3627
US

IV. Provider business mailing address

514 S BAY RD
SYRACUSE NY
13212-3627
US

V. Phone/Fax

Practice location:
  • Phone: 315-458-1777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number007525
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number007525
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: