Provider Demographics
NPI:1154584688
Name:UPSTATE UNIVERSITY HOSPITAL
Entity type:Organization
Organization Name:UPSTATE UNIVERSITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVATE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAIRALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-464-5800
Mailing Address - Street 1:460 S MAIN ST APT 246
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-3050
Mailing Address - Country:US
Mailing Address - Phone:315-450-3567
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2342
Practice Address - Country:US
Practice Address - Phone:315-464-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NOT YET LICENSED282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren