Healthcare Provider Details

I. General information

NPI: 1750389797
Provider Name (Legal Business Name): AHMED M BAYOUMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2261 STATE ROUTE 19 N
WARSAW NY
14569-9334
US

IV. Provider business mailing address

PO BOX 230
WARSAW NY
14569-0230
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-2290
  • Fax: 585-786-2853
Mailing address:
  • Phone: 585-786-2290
  • Fax: 585-786-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number210742
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: