Provider Demographics
NPI:1790164564
Name:AYAZ, MUDDUSIR MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MUDDUSIR
Middle Name:MOHAMMAD
Last Name:AYAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MUDDASIR
Other - Middle Name:MOHAMMAD
Other - Last Name:AYAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:260 LEIGH FARM
Mailing Address - Street 2:320
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707
Mailing Address - Country:US
Mailing Address - Phone:562-325-3697
Mailing Address - Fax:
Practice Address - Street 1:20 HAGEN DR STE 330
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2664
Practice Address - Country:US
Practice Address - Phone:585-267-4040
Practice Address - Fax:585-267-4044
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC209950207R00000X
NY294263207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine