Provider Demographics
NPI:1619263829
Name:IMRAN, SIKANDAR SHAHZAD (MD)
Entity type:Individual
Prefix:
First Name:SIKANDAR
Middle Name:SHAHZAD
Last Name:IMRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3001
Mailing Address - Country:US
Mailing Address - Phone:585-922-5067
Mailing Address - Fax:585-922-2908
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-922-5067
Practice Address - Fax:585-922-2908
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275179208M00000X, 207R00000X
DCMD043879207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03884306Medicaid
NY03007063/NWKMedicaid
NY01131126/RGHMedicaid
NY70005A/RGHMedicare PIN
NY03884306Medicaid
NY01131126/RGHMedicaid
NY10712A/NWKMedicare PIN