Provider Demographics
NPI:1205377496
Name:RAHMATULLAH, SYED ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:ALI
Last Name:RAHMATULLAH
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 1:1900 EMPIRE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1934
Mailing Address - Country:US
Mailing Address - Phone:585-787-0720
Mailing Address - Fax:
Practice Address - Street 1:1900 EMPIRE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1934
Practice Address - Country:US
Practice Address - Phone:585-787-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA284119207Q00000X
NY322214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine