Provider Demographics
NPI:1376707521
Name:WASSEL, ANWAR (MD)
Entity Type:Individual
Prefix:
First Name:ANWAR
Middle Name:
Last Name:WASSEL
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:PO BOX 821
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-0821
Mailing Address - Country:US
Mailing Address - Phone:315-624-9000
Mailing Address - Fax:315-624-9003
Practice Address - Street 1:1450 CHAMPLIN AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3662
Practice Address - Country:US
Practice Address - Phone:315-624-9000
Practice Address - Fax:315-624-9003
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242965-1207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03040824Medicaid
NY242965-1OtherSTATE LICENSE
NY03040824Medicaid