Provider Demographics
NPI:1962439786
Name:MEHDI, SYED R (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:R
Last Name:MEHDI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:191 SOCIAL STREET
Mailing Address - Street 2:THUNDERMIST HEALTH CENTER
Mailing Address - City:WOONSOCKER
Mailing Address - State:RI
Mailing Address - Zip Code:02895
Mailing Address - Country:US
Mailing Address - Phone:401-767-4163
Mailing Address - Fax:401-767-4165
Practice Address - Street 1:450 CLINTON STREET
Practice Address - Street 2:THUNDERMIST HEALTH CENTER
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895
Practice Address - Country:US
Practice Address - Phone:401-767-4100
Practice Address - Fax:401-235-6893
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-05-09
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Provider Licenses
StateLicense IDTaxonomies
RIMD09521207QG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
007058376Medicare ID - Type Unspecified
G51471Medicare UPIN