Healthcare Provider Details

I. General information

NPI: 1235201559
Provider Name (Legal Business Name): JAMES DICKSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORTH ST SUITE 101
GENEVA NY
14456-1561
US

IV. Provider business mailing address

200 NORTH ST SUITE 101
GENEVA NY
14456-1561
US

V. Phone/Fax

Practice location:
  • Phone: 315-787-5100
  • Fax: 315-787-5108
Mailing address:
  • Phone: 315-787-5100
  • Fax: 315-787-5108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number124504
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: