Healthcare Provider Details

I. General information

NPI: 1912995978
Provider Name (Legal Business Name): ROSEMARIE HURLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 STATE ROUTE 281
CORTLAND NY
13045-1637
US

IV. Provider business mailing address

4077 STATE ROUTE 281
CORTLAND NY
13045-1637
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-9977
  • Fax: 607-753-7311
Mailing address:
  • Phone: 607-753-9977
  • Fax: 607-753-7311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number161949
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: