Individual
MARIE-JEANNE DESRAVINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
522 S 4TH ST, SUITE 500, FULTON, NY 13069-2946
(315) 598-4740
(315) 598-4719
Mailing address
239 ONEIDA ST, FULTON, NY 13069-1228
(315) 598-4715
(315) 598-4733
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
221962
NY
Other
Enumeration date
08/24/2006
Last updated
07/08/2007
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