NPI

Wisam Al-Mutawalli

This page is a copy of the public NPPES file.

Facts

Status
Active
Credential
MD
Type
Individual
Enumeration date
2021-05-04
Last updated
2024-10-23

Specialties

Licenses

License NY
332191

Location

Practice location
208 Township Blvd, Ste 100
City
Camillus NY
Postal code
13031
Phone
(315) 551-6000

Medicare

PECOS
A PECOS enrollment row matches this NPI.

LEIE

No exclusion found for this NPI in the OIG LEIE file dated October 9, 2026. OIG's online search is the official check.

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Nearby

Other NPIs in Camillus, NY. 469 records in the public file.

Removal request

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