Provider Demographics
NPI:1356394761
Name:ABDELAZIZ, BAHGAT HAMDI (PA)
Entity type:Individual
Prefix:
First Name:BAHGAT
Middle Name:HAMDI
Last Name:ABDELAZIZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1829
Mailing Address - Country:US
Mailing Address - Phone:315-258-8282
Mailing Address - Fax:315-258-7386
Practice Address - Street 1:132 NORTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1829
Practice Address - Country:US
Practice Address - Phone:315-258-8282
Practice Address - Fax:315-258-7386
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011062363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ58409Medicare UPIN
NYPA1174Medicare ID - Type Unspecified