Provider Demographics
NPI:1245393040
Name:KAAKOUR, MUSTAFA (MD)
Entity Type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:
Last Name:KAAKOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MUSTAFA
Other - Middle Name:ABDUL HADI
Other - Last Name:KA' KUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:117 SYLVAN WAY
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-3436
Mailing Address - Country:US
Mailing Address - Phone:315-724-4429
Mailing Address - Fax:315-724-4429
Practice Address - Street 1:1656 CHAMPLIN AVE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4830
Practice Address - Country:US
Practice Address - Phone:315-797-0790
Practice Address - Fax:315-624-8204
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1894621207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY81472OtherEMPIRE BC BS
NY81472OtherEMPIRE BC BS