Healthcare Provider Details

I. General information

NPI: 1417905977
Provider Name (Legal Business Name): CORTLAND MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 FISHER AVE
CORTLAND NY
13045-1012
US

IV. Provider business mailing address

1001 W FAYETTE ST SUITE 400
SYRACUSE NY
13204-2859
US

V. Phone/Fax

Practice location:
  • Phone: 607-756-4600
  • Fax: 607-753-6266
Mailing address:
  • Phone: 315-472-1488
  • Fax: 315-472-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: PATRICK J. HAYES
Title or Position: DIRECTOR
Credential: MD
Phone: 607-756-4600