Basic Information
| Provider Information | |||||||||
| NPI: | 1639140734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHOUTHRY | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2000 | ||||||||
| Address2: | ENROLLMENT DEPT | ||||||||
| City: | EAST SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130574500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153625129 | ||||||||
| FaxNumber: | 3153625179 | ||||||||
| Practice Location | |||||||||
| Address1: | 1676 SUNSET AVE | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 135025416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157243456 | ||||||||
| FaxNumber: | 3157246734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2006 | ||||||||
| LastUpdateDate: | 02/12/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 226748 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 226748 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.