Provider Demographics
NPI:1043767734
Name:MAKHDOM, ASIM (MD)
Entity Type:Individual
Prefix:
First Name:ASIM
Middle Name:
Last Name:MAKHDOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:908 NIAGARA FALLS BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:741-669-2330
Mailing Address - Fax:716-692-4342
Practice Address - Street 1:195 PLEASANT STREET, SUITE 5
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701
Practice Address - Country:US
Practice Address - Phone:814-362-5701
Practice Address - Fax:814-362-5702
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY287870207X00000X
PAMD456673207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04760550Medicaid