Provider Demographics
NPI:1831388743
Name:SAGCAN, OMER (MD)
Entity type:Individual
Prefix:
First Name:OMER
Middle Name:
Last Name:SAGCAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PROSPECT AVE
Mailing Address - Street 2:C/O HOSPITAL INTERNISTS
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1807
Mailing Address - Country:US
Mailing Address - Phone:315-448-5704
Mailing Address - Fax:315-423-6852
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:C/O HOSPITAL INTERNISTS
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-5704
Practice Address - Fax:315-423-6852
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 246502207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02921722Medicaid
NY02921722Medicaid
RB6138Medicare PIN