Provider Demographics
NPI:1083651285
Name:MAGHAYDAH, QUTAYBEH S (MD)
Entity Type:Individual
Prefix:
First Name:QUTAYBEH
Middle Name:S
Last Name:MAGHAYDAH
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 1:1001 W FAYETTE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-472-1488
Mailing Address - Fax:315-476-1792
Practice Address - Street 1:310 TAUGHANNOCK BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3231
Practice Address - Country:US
Practice Address - Phone:607-269-0100
Practice Address - Fax:607-269-0140
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY234099207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00428919Medicare PIN
NYRB0428Medicare PIN
NYG42849Medicare UPIN