Healthcare Provider Details

I. General information

NPI: 1093954406
Provider Name (Legal Business Name): MARIA IANNOLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 FLY RD
EAST SYRACUSE NY
13057-9717
US

IV. Provider business mailing address

6620 FLY RD
EAST SYRACUSE NY
13057-9717
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-4472
  • Fax: 315-464-5222
Mailing address:
  • Phone: 315-464-4472
  • Fax: 315-464-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number257969
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: