Basic Information
Provider Information | |||||||||
NPI: | 1164547899 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RAMAZANOGLU | ||||||||
FirstName: | MEHMET | ||||||||
MiddleName: | FATIH | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | RAMAZANOGLU | ||||||||
OtherFirstName: | MEHMET | ||||||||
OtherMiddleName: | FATIH | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 11050 MOUNT BELVEDERE BLVD | ||||||||
Address2: |   | ||||||||
City: | FORT DRUM | ||||||||
State: | NY | ||||||||
PostalCode: | 136025438 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3157721648 | ||||||||
FaxNumber: | 3159653703 | ||||||||
Practice Location | |||||||||
Address1: | 1001 WEST ST | ||||||||
Address2: |   | ||||||||
City: | CARTHAGE | ||||||||
State: | NY | ||||||||
PostalCode: | 136199703 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3154939400 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/20/2007 | ||||||||
LastUpdateDate: | 12/22/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/21/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 170898 | NY | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | B82952 | 01 |   | UPIN | OTHER |