Provider Demographics
NPI:1497918890
Name:MAKHLOUF, FADI NICOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:FADI
Middle Name:NICOLA
Last Name:MAKHLOUF
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 1:792 N MAIN ST
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1644
Mailing Address - Country:US
Mailing Address - Phone:315-423-9722
Mailing Address - Fax:315-423-9687
Practice Address - Street 1:770 JAMES ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2117
Practice Address - Country:US
Practice Address - Phone:315-422-2222
Practice Address - Fax:315-472-8497
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248976207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03015703Medicaid
NYJ400062231Medicare UPIN
NY01380574Medicaid
NYJA00062231Medicare PIN
NYB 80939Medicare UPIN
CC 4042Medicare UPIN
CC 8274Medicare UPIN
NYG 07723Medicare UPIN
NY01459874Medicaid
NY03015703Medicaid
NY00731128Medicare UPIN
NY00373377Medicaid
NY01583348Medicaid
33882LMedicare UPIN
NYQ 21618Medicare UPIN
NY02703184Medicaid
NYE 61173Medicare UPIN
E 94510Medicare UPIN
G 12077Medicare UPIN
NY02150663Medicaid
NY02240673Medicaid
NY02384169Medicaid