Healthcare Provider Details

I. General information

NPI: 1477221141
Provider Name (Legal Business Name): ISMAT MRAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 N MAIN ST
WELLSVILLE NY
14895-1150
US

IV. Provider business mailing address

97 FAIRLAWN AVE
HORNELL NY
14843-1744
US

V. Phone/Fax

Practice location:
  • Phone: 313-657-3696
  • Fax:
Mailing address:
  • Phone: 313-657-3696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number321205
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: