Provider Demographics
NPI:1134245152
Name:SYED S HYDER
Entity type:Organization
Organization Name:SYED S HYDER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:S
Authorized Official - Last Name:HYDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-625-3171
Mailing Address - Street 1:123 GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-0848
Mailing Address - Country:US
Mailing Address - Phone:724-625-3171
Mailing Address - Fax:724-625-3510
Practice Address - Street 1:123 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046
Practice Address - Country:US
Practice Address - Phone:724-625-3171
Practice Address - Fax:724-625-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052414L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010947930001Medicaid
PA1561031OtherHIGHMARK
PADG2292OtherRAILROAD MEDICARE
PA1010947930001Medicaid