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NPI Code Detail

MEDICARE: SOUBHI AZAR M.D.

MEDICARE: SOUBHI AZAR M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician275660NY

General Provider Information

NPI Number : 1457646341
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOUBHI AZAR M.D.
Provider Business Mailing Address
First Line : 1001 W FAYETTE ST
Second Line : SUITE 400
City : SYRACUSE
State : NY
Zip : 13204-2859
Country : US
Telephone Number : 315-472-1488
Fax Number : 315-472-8060
Provider Business Practice Location Address
First Line : 4500 PEWTER LN BLDG 1
Second Line :
City : MANLIUS
State : NY
Zip : 13104-7704
Country : US
Telephone Number : 315-682-6600
Fax Number : 315-682-0570
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2011
Last Update Date : 09/02/2025

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