Healthcare Provider Details

I. General information

NPI: 1134245152
Provider Name (Legal Business Name): SYED S HYDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 GRAND AVENUE
MARS PA
16046
US

IV. Provider business mailing address

123 GRAND AVENUE
MARS PA
16046-0848
US

V. Phone/Fax

Practice location:
  • Phone: 724-625-3171
  • Fax: 724-625-3510
Mailing address:
  • Phone: 724-625-3171
  • Fax: 724-625-3510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD052414L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1010947930001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1561031
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK
# 3
IdentifierDG2292
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name: DR. SYED S HYDER
Title or Position: OWNER
Credential: MD
Phone: 724-625-3171