Provider Demographics
NPI:1073651485
Name:MASOODI, GHULAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:GHULAM
Middle Name:S
Last Name:MASOODI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 FRENCH RD # B
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-3632
Mailing Address - Country:US
Mailing Address - Phone:716-668-2592
Mailing Address - Fax:716-668-1383
Practice Address - Street 1:928 FRENCH RD # B
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-3632
Practice Address - Country:US
Practice Address - Phone:716-668-2592
Practice Address - Fax:716-668-1383
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130424207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00685887Medicaid
NYB71789Medicare UPIN
NY00685887Medicaid