Individual
MITRA GHASEMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
90 PRESIDENTIAL PLZ FL 2, SYRACUSE, NY 13202-2240
(315) 464-3835
Mailing address
251 SALINA MEADOWS PKWY STE 100, SYRACUSE, NY 13212-4516
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
229777
MA
207R00000X
Internal Medicine Physician
303813
NY
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
303813
NY
207RP1001X
Pulmonary Disease Physician
229777
MA
207RP1001X
Pulmonary Disease Physician
Primary
303813
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2147670
—
MA
Enumeration date
01/29/2007
Last updated
08/03/2022
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