Provider Demographics
NPI:1215017371
Name:SHAWL, AJAZ B (MD, FACP)
Entity Type:Individual
Prefix:
First Name:AJAZ
Middle Name:B
Last Name:SHAWL
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 UNION AVE. SUITE 806
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203
Mailing Address - Country:US
Mailing Address - Phone:315-703-5180
Mailing Address - Fax:315-703-2567
Practice Address - Street 1:182 INTREPID LN
Practice Address - Street 2:BRIGHTON MEDICAL ASSOCIATES
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205
Practice Address - Country:US
Practice Address - Phone:315-218-7020
Practice Address - Fax:315-218-7050
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG16507Medicare UPIN
NYRB2349Medicare PIN
NYP00379365Medicare PIN