Provider Demographics
NPI:1528014289
Name:SYED, KHALID MAZHAR (MD)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:MAZHAR
Last Name:SYED
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 1:496 LYNNFIELD STREET
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904
Mailing Address - Country:US
Mailing Address - Phone:781-593-3400
Mailing Address - Fax:781-477-1195
Practice Address - Street 1:496 LYNNFIELD ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904
Practice Address - Country:US
Practice Address - Phone:781-593-3400
Practice Address - Fax:781-477-1195
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77575207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110057233AMedicaid
MA3153258Medicaid
G07656Medicare UPIN
A2031801Medicare PIN
MA3153258Medicaid