Healthcare Provider Details

I. General information

NPI: 1972501682
Provider Name (Legal Business Name): MICHAEL L. PRYCE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 COMMONS AVE
CORTLAND NY
13045-1643
US

IV. Provider business mailing address

134 HOMER AVE
CORTLAND NY
13045-1206
US

V. Phone/Fax

Practice location:
  • Phone: 607-758-3750
  • Fax: 607-758-3754
Mailing address:
  • Phone: 607-758-8019
  • Fax: 607-758-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number35-04-2582-P
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number280178
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: