1245483965 NPI number — DR. ADEEB H AL-QUTHAMI MD

Table of content: (NPI 1215327531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245483965 NPI number — DR. ADEEB H AL-QUTHAMI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AL-QUTHAMI
Provider First Name:
ADEEB
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245483965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT. OF MEDICINE MEDICAL SERVICE GROUP
Provider Second Line Business Mailing Address:
90 PRESIDENTIAL PLAZA, SUITE 5010
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-464-9335
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 RESNIK RD LOWR LEVEL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02360-7211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-746-2900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  338450 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 253841 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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