Healthcare Provider Details

I. General information

NPI: 1821559329
Provider Name (Legal Business Name): TYLER PLUCHINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ATWELL RD
COOPERSTOWN NY
13326
US

IV. Provider business mailing address

1 ATWELL RD
COOPERSTOWN NY
13326
US

V. Phone/Fax

Practice location:
  • Phone: 607-547-3456
  • Fax:
Mailing address:
  • Phone: 607-547-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2024026116
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number338251
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number04-49475
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: