Healthcare Provider Details

I. General information

NPI: 1427797190
Provider Name (Legal Business Name): VIRGINIA BERSANI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIRGINIA STODDARD-MERRIAM D.O.

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 TECHNOLOGY PL
HOMER NY
13077-1526
US

IV. Provider business mailing address

85 S WEST ST
HOMER NY
13077-1542
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-3774
  • Fax: 607-753-3947
Mailing address:
  • Phone: 607-753-3797
  • Fax: 607-218-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number342362
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS024812
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: