Provider Demographics
NPI:1477657641
Name:IMDAD, SULTAN MAHMOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:SULTAN
Middle Name:MAHMOOD
Last Name:IMDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SULTAN
Other - Middle Name:M
Other - Last Name:IMDAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1000 WEST ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-9761
Mailing Address - Country:US
Mailing Address - Phone:315-493-4149
Mailing Address - Fax:
Practice Address - Street 1:CARTHAGE AREA HOSPITAL
Practice Address - Street 2:BRIDGE STREET
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619
Practice Address - Country:US
Practice Address - Phone:315-493-4180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine