Provider Demographics
NPI:1154306900
Name:SYEDA AWAIS MD
Entity Type:Organization
Organization Name:SYEDA AWAIS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SYEDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AWAIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-595-0531
Mailing Address - Street 1:299 CAREW ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2301
Mailing Address - Country:US
Mailing Address - Phone:508-595-0531
Mailing Address - Fax:508-829-5367
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:SUITE 230
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2301
Practice Address - Country:US
Practice Address - Phone:413-733-8129
Practice Address - Fax:413-733-9441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79722208000000X
363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9785795Medicaid
MAM17344OtherBLUE CROSS BLUE GRP NUMBE