Healthcare Provider Details

I. General information

NPI: 1225003767
Provider Name (Legal Business Name): SPENCER P. ANNABEL M.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CROSBY ST
HORNELL NY
14843-1709
US

IV. Provider business mailing address

111 E 14TH ST
ELMIRA HEIGHTS NY
14903-1303
US

V. Phone/Fax

Practice location:
  • Phone: 607-324-1874
  • Fax: 607-324-1140
Mailing address:
  • Phone: 607-734-9539
  • Fax: 607-734-6293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number120290-1
License Number StateNY

VIII. Authorized Official

Name: SPENCER P ANNABEL
Title or Position: MD
Credential: MD
Phone: 607-324-1874