Individual
JOHN RAYMOND WANAMAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 IRVING AVE, VA MEDICAL CENTER, SURGICAL SERVICES(112), SYRACUSE, NY 13210-2716
(315) 425-4400
(315) 425-2639
Mailing address
800 IRVING AVE, VA MEDICAL CENTER, SURGICAL SERVICES(112), SYRACUSE, NY 13210-2716
(315) 425-4400
(315) 425-2639
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
189611
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01635029
—
NY
Enumeration date
10/05/2005
Last updated
12/20/2016
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