Individual
IN WHAN OH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4038 WEST RD, CORTLAND, NY 13045-1842
(607) 758-3008
(607) 758-9515
Mailing address
85 S WEST ST, HOMER, NY 13077-1542
(607) 753-3797
(607) 753-6677
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
1472741
NY
207VG0400X
Gynecology Physician
1472741
NY
207VX0000X
Obstetrics Physician
1472741
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00718589
—
NY
Enumeration date
11/08/2006
Last updated
05/03/2018
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