Basic Information
| Provider Information | |||||||||
| NPI: | 1316167547 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SYED | ||||||||
| FirstName: | SYYEDA | ||||||||
| MiddleName: | FOUZIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FATIMA | ||||||||
| OtherFirstName: | SYYEDA | ||||||||
| OtherMiddleName: | FOUZIA | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 176 S. COLDBROOK AVENUE | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172677480 | ||||||||
| FaxNumber: | 7172174216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2007 | ||||||||
| LastUpdateDate: | 09/14/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MT185023 | PA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | D0071957 | MD | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | MD432876 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1911913 | 01 | PA | AETNA HMO | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | FS0588585 | 01 | PA | DEA | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | 9598206 | 01 | PA | AETNA NON-HMO | OTHER | P00700659 | 01 | PA | RAILROAD MEDICARE | OTHER | 120420406 | 01 | PA | DEPT OF LABOR | OTHER | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | MD432876 | 01 | PA | PA MEDICAL LICENSE | OTHER | SY2056235 | 01 | PA | HIGHMARK BLUESHIELD | OTHER | 102167268 0001 | 05 | PA | MEDICAID | 25-1716306 | 01 | PA | INFORMED | OTHER | G920-0103/233CCU | 01 | PA | CAREFIRST | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | 1007307260034 | 01 | PA | MEDICAID GROUP # | OTHER | 25-1716306 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER | 50078616 | 01 | PA | CAPITAL BLUECROSS | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER |