Provider Demographics
NPI:1033105721
Name:OBEID, ANIS I (MD FACC)
Entity Type:Individual
Prefix:
First Name:ANIS
Middle Name:I
Last Name:OBEID
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 S CROUSE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1754
Mailing Address - Country:US
Mailing Address - Phone:315-470-7825
Mailing Address - Fax:315-470-2919
Practice Address - Street 1:736 IRVING AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1687
Practice Address - Country:US
Practice Address - Phone:315-470-7409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100016207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00447190Medicaid
NYRB6634Medicare PIN
NY060012234Medicare PIN
NYRB8262Medicare PIN
NY39085CMedicare PIN
NYCC9042Medicare PIN
NYP00649641Medicare PIN
B79470Medicare UPIN