Provider Demographics
NPI:1952806242
Name:WADY, HEITHAM (MD)
Entity type:Individual
Prefix:DR
First Name:HEITHAM
Middle Name:
Last Name:WADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6711 TOWPATH RD
Mailing Address - Street 2:#175
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9212
Mailing Address - Country:US
Mailing Address - Phone:315-458-2211
Mailing Address - Fax:315-452-9025
Practice Address - Street 1:6711 TOWPATH RD
Practice Address - Street 2:#175
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9212
Practice Address - Country:US
Practice Address - Phone:315-458-2211
Practice Address - Fax:315-452-9025
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NY329224208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07989137Medicaid