Active NPI
Waguih S Kirollos, MD
- Gynecology Physician
- Saranac Lake, NY
National Provider Identifier
1407861370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 190692-1
- Practice address
- 2249 State Route 86
Suite 4
Saranac Lake, NY 12983-5644 - Phone
- (518) 891-5077
- Fax
- (518) 891-3381
- NPI assigned
- Jul 29, 2006
- Last updated
- Jan 14, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 190692-1 | NY | Primary |
Addresses
Primary practice location
2249 State Route 86
Suite 4
Saranac Lake, NY 12983-5644
Mailing address
2249 State Route 86
Suite 4
Saranac Lake, NY 12983-5644
Phone (518) 891-5077
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01529419 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 190692-1 | NY | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578960000000",
"number": "1407861370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2249 STATE ROUTE 86",
"address_2": "SUITE 4",
"city": "SARANAC LAKE",
"state": "NY",
"postal_code": "129835644",
"telephone_number": "518-891-5077",
"fax_number": "518-891-3381"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2249 STATE ROUTE 86",
"address_2": "SUITE 4",
"city": "SARANAC LAKE",
"state": "NY",
"postal_code": "129835644",
"telephone_number": "518-891-5077",
"fax_number": "518-891-3381"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIROLLOS",
"first_name": "WAGUIH",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-29",
"last_updated": "2020-01-14",
"certification_date": "2020-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "NY",
"license": "190692-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01529419",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saranac Lake, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.