Provider Demographics
NPI:1346472826
Name:WALI, SYED ARMOGHAN (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:ARMOGHAN
Last Name:WALI
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 1:50 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1799
Mailing Address - Country:US
Mailing Address - Phone:315-265-3300
Mailing Address - Fax:315-261-6025
Practice Address - Street 1:15 RAYMOND ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1163
Practice Address - Country:US
Practice Address - Phone:315-265-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125056998208000000X
AL31880208000000X
NY296489208000000X
NY125056998208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-30395 (SBC)OtherBLUE CROSS
AL183210Medicaid
AL141862 (SBC)Medicaid
AL142072 (STEWART)Medicaid
AL511-30389 (COMPLEX)OtherBLUE CROSS
AL511-73964OtherBCBS OF ALABAMA
AL141861 (COMPLEX)Medicaid
AL511-30392(STEWART)OtherBLUE CROSS