Provider Demographics
NPI:1992727721
Name:POHAR, BOBBY (MD)
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:POHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PROSPECT AVE
Mailing Address - Street 2:MEDICAL EDUCATION
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1807
Mailing Address - Country:US
Mailing Address - Phone:315-448-5547
Mailing Address - Fax:315-448-6313
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:MEDICAL EDUCATION
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-5547
Practice Address - Fax:315-448-6313
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02393653Medicaid
RB1778Medicare PIN
NY02393653Medicaid
P00363409Medicare PIN