Provider Demographics
NPI:1770528267
Name:WARIS, GOLAM MOSTAFA (MD)
Entity type:Individual
Prefix:DR
First Name:GOLAM
Middle Name:MOSTAFA
Last Name:WARIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2603 OSBORNE RD STE E
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-8907
Mailing Address - Country:US
Mailing Address - Phone:912-510-3420
Mailing Address - Fax:912-510-4375
Practice Address - Street 1:2200 GENESEE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-1924
Practice Address - Country:US
Practice Address - Phone:313-891-5437
Practice Address - Fax:313-891-0842
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY296648207R00000X
MI4301076162207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4670900Medicaid
MIH87978Medicare UPIN
MI0N74120Medicare ID - Type Unspecified