MEDICARE: DR. JOSE MARIA ACOSTAMADIEDO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	291399	NY

General Provider Information

NPI Number	:	1013910256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE MARIA ACOSTAMADIEDO MD

Provider Business Mailing Address
First Line	:	212 CORNELIA ST
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-2306
Country	:	US
Telephone Number	:	518-562-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 CORNELIA ST
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-2306
Country	:	US
Telephone Number	:	518-562-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/11/2017

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